About the Role

The Authorizations Coordinator is responsible for managing the end-to-end prior authorization and referral process for patient services. This role ensures that authorization requests are accurately initiated, tracked, followed up on, and completed in accordance with payer requirements, medical policies, and client expectations.

The ideal candidate has experience in prior authorizations, medical billing, or revenue cycle management, with strong attention to detail, excellent communication skills, and the ability to manage a high-volume workload in a remote environment.

Key Responsibilities

• Receive, review, and process prior authorization and referral requests accurately and in a timely manner.
• Initiate, track, and follow up on authorization requests from submission through final determination.
• Review patient cases, medical documentation, CPT codes, ICD-10 diagnosis codes, and payer requirements to determine authorization needs and likely outcomes.
• Verify patient demographics, insurance eligibility, benefits, referral requirements, and coverage details.
• Obtain, review, and enter insurance authorizations and referrals prior to patient services.
• Work within EMRs, payer portals, and authorization platforms such as Availity or similar systems.
• Communicate with provider offices, physicians’ offices, insurance representatives, and internal teams to gather required documentation and resolve authorization issues.
• Assist patients, when appropriate, with collecting supporting documents needed for authorization processing.
• Maintain accurate logs of open cases, pending documents, payer follow-ups, action items, and case outcomes.
• Monitor authorization status and follow up with insurance companies to prevent delays in patient care or claim processing.
• Identify and escalate issues related to denials, missing documentation, payer discrepancies, or authorization delays.
• Respond to emails, phone calls, and internal messages in a timely and professional manner.
• Support benefit verification tasks for patients and clients as needed.
• Assist with customer service calls and route inquiries appropriately.
• Maintain productivity expectations, including daily or weekly case submission and follow-up targets.
• Perform other duties as assigned.

Qualifications

• 1–3+ years of experience in prior authorizations, medical billing, revenue cycle management, or a related healthcare administrative role.
• Strong knowledge of insurance verification, benefits, referrals, payer requirements, and authorization workflows.
• Experience using EMRs, payer portals, and authorization platforms such as Availity or similar tools.
• Familiarity with CPT coding, ICD-10 diagnosis codes, and medical documentation review.
• Understanding of payer policies, authorization requirements, denial scenarios, and follow-up processes.
• Ability to accurately verify patient demographics, insurance eligibility, benefits, and required documentation.
• Proficiency in Microsoft Office tools, including Excel, Outlook, and Teams.
• Comfortable working with general workflow tools, web browsers, softphone systems, and healthcare technology platforms.
• Ability to manage high-volume case loads while meeting submission targets and deadlines.
• Strong written and verbal communication skills.
• Excellent organizational skills and attention to detail.
• Ability to assess problem areas, identify root causes, and resolve issues effectively.
• Strong time management and prioritization skills, especially when handling urgent versus routine cases.
• Ability to multi-task in a fast-paced environment.
• Customer and client-focused approach with a commitment to responsiveness and service quality.
• Ability to work full-time during regularly scheduled business hours, with additional hours as needed.
• Ability to work from home with integrity, accountability, and professionalism.

Key Competencies

• Attention to Detail — Ensures accuracy in coding, benefits verification, documentation, and authorization submissions.
• Time Management — Prioritizes urgent and routine cases effectively while maintaining productivity.
• Problem-Solving — Identifies issues related to denials, missing documentation, payer discrepancies, and authorization delays.
• Communication — Interacts professionally with provider offices, insurance representatives, patients, and internal teams.
• Customer/Client Focus — Maintains high-quality service and responsiveness across all communication channels.
• Accountability — Takes ownership of assigned cases and follows through until completion.