Pre-Authorization & Referral Coordinator

My VA Support, Inc.; United States; Remote; USD 52,000 - 68,000; Full time

Benefits offered by this job

100% Remote position

Full-time schedule (Mon-Fri)

Weekends off

Remote payment bonuses

Job summary

My VA Support, Inc. seeks an experienced Pre-Authorization & Referral Coordinator for a full-time remote role supporting a U.S.-based medical office. The candidate must be LATAM-based and bilingual in Spanish and English.

The position requires expertise in insurance verification, prior authorizations, and referral coordination while maintaining compliance with U.S. guidelines. Independent contractor opportunity offered.

Qualifications

• 2+ years of experience in a U.S. medical office handling insurance verification and prior authorizations.
• Direct experience obtaining authorizations independently.
• Strong knowledge of Medicare, Medicaid, and commercial plans (HMO, PPO, POS).
• Understanding of deductibles, copays, coinsurance, and out-of-pocket maximums.

Responsibilities

• Verify active insurance coverage and review detailed benefits.
• Determine patient financial responsibility (copays, deductibles, coinsurance, out-of-pocket maximums).
• Obtain and manage prior authorizations for procedures, imaging, and specialty services.
• Submit and track authorization requests through payer portals (Availity, UHC, Aetna, Cigna, etc.).
• Review and attach required clinical documentation.
• Process and track internal and external referrals.
• Ensure compliance with HMO referral requirements.
• Enter and document authorization details in EMR/EHR systems.
• Follow up on pending authorizations and assist with resolving denials.
• Communicate insurance requirements and authorization status clearly to patients.

Skills

Insurance verification

Prior authorizations

Payer portals

English communication

Tools

Availity

UnitedHealthcare

Aetna

Cigna

EMR/EHR systems

Job description

This is a remote position. Only LATAM-based candidates (bilingual in Spanish and English) We are hiring an experienced Pre-Authorization & Referral Coordinator to support a fast-paced U.S.-based medical office . This role is responsible for insurance verification, prior authorizations, and referral coordination while ensuring compliance with U.S. insurance guidelines. The ideal candidate has direct experience working within the U.S. healthcare system handling Medicare, Medicaid, and commercial insurance plans. This is a full-time remote position supporting a medical practice located in the United States. The role is offered as an Independent Contractor opportunity.

Key Responsibilities

• Verify active insurance coverage and review detailed benefits
• Determine patient financial responsibility (copays, deductibles, coinsurance, out-of-pocket maximums)
• Obtain and manage prior authorizations for procedures, imaging, and specialty services
• Submit and track authorization requests through payer portals (Availity, UHC, Aetna, Cigna, etc.)
• Review and attach required clinical documentation
• Process and track internal and external referrals
• Ensure compliance with HMO referral requirements
• Enter and document authorization details in EMR/EHR systems
• Follow up on pending authorizations and assist with resolving denials
• Communicate insurance requirements and authorization status clearly to patients

Requirements

• 2+ years of experience in a U.S. medical office handling insurance verification and prior authorizations
• Proven hands-on experience obtaining authorizations independently (not only assisting)
• Strong knowledge of Medicare, Medicaid, and commercial plans (HMO, PPO, POS)
• Solid understanding of deductibles, copays, coinsurance, and out-of-pocket maximums
• Working knowledge of ICD-10 and CPT codes
• Experience using payer portals (Availity, UnitedHealthcare, Aetna, Cigna, etc.)
• Experience working with EMR/EHR systems
• High attention to detail and ability to manage high-volume workflows
• Strong English communication skills (written and verbal)
• Reliable high-speed internet connection (minimum 100 MB)
• Own laptop or desktop and professional headset

Benefits

• 100% Remote position
• Full-time schedule (Monday–Friday)
• Weekends off
• Productivity bonus of 50 USD (paid in local currency)
• Reliability bonus of 25 USD (paid in local currency)
• Consecutive reliability bonus of 50 USD (paid in local currency)

Originally posted on Himalayas