Prior Authorization & Referral Coordinator

Job Description

Job Description

Job Description: Prior Authorization & Referral Coordinator

Position Overview:

OPN is seeking a highly organized and proactive Prior Authorization & Referral Coordinator to join our clinical and care coordination teams. The ideal candidate will play a critical role in ensuring seamless and compliant authorization and referral processes, contributing to optimized patient care and operational efficiency. This position requires strong attention to detail, excellent communication skills, and a collaborative approach to problem-solving.

Essential Duties and Responsibilities:

• Prior Authorization Management: Accurately submit prior authorization requests for medical procedures, treatments, and medications to insurance payers, ensuring compliance with payer guidelines.

• Tracking & Reporting: Maintain and update authorization tracking systems, including data entry, status updates, and generating reports for internal use.

• Referral Coordination: Manage detailed records of referrals and authorizations, ensuring timely communication with providers and internal teams.

• Documentation Updates: Update patient records with authorization statuses, referral details, and other relevant information in the Electronic Health Record (EHR) system.

• Insurance Verification: Determine the need for prior authorization based on insurance guidelines and verify patient eligibility.

• Medical Records Review: Compile necessary medical documentation for prior authorization submissions while adhering to HIPAA regulations.

• Compliance Assurance: Ensure adherence to health plan policies, regulatory requirements, and organizational standards.

 

Education and Work Experience Requirements:

• Minimum of 2 years of experience in prior authorization or referral coordination.

• High school diploma or equivalent; additional certifications in healthcare administration or related fields preferred.

• Oncology experience is a plus but not required.

• Proven ability to work independently while managing multiple tasks efficiently within deadlines.

 

Skills & Competencies:

• Exceptional organizational skills with keen attention to detail.

• Strong verbal and written communication skills for effective collaboration with internal teams and external stakeholders.

• Proficiency in Microsoft Office Suite (Excel, Word) and familiarity with EHR systems.

• Analytical problem-solving capabilities to address administrative challenges efficiently.

• Ability to maintain confidentiality when handling sensitive patient information.

 

Physical Requirements:

• Ability to perform job functions safely and effectively in compliance with ADA standards.

• Regular attendance and punctuality are essential for this role.

• Must be able to communicate clearly via telephone and other communication tools.

 

Why Join OPN?

This position offers the opportunity to make a meaningful impact on patient care by ensuring timely access to necessary medical services. If you thrive in a fast-paced healthcare environment that values precision, teamwork, and patient-centered care, we encourage you to apply

Company Description

Oncology Physicians Network offers a unique platform of oncology care services leading the industry in value-based clinical and financial outcomes. OPN currently serves 1.7 million health plan beneficiaries in 3 states. OPN is aggressively expanding its large and successful California business model across the country.

OPN partners with physicians and aligns their practices with health insurance organizations and other healthcare payors to deliver industry-leading oncology care while managing costs efficiently. OPN has a demonstrated track record in assisting payors to reduce the increasing costs of medical oncology through a value-based methodology.

OPN Healthcare is committed to creating a diverse environment and is proud to be an equal opportunity employer.

OPN supports a healthy work life balance and provides a comprehensive benefits package.

Company Description

Oncology Physicians Network offers a unique platform of oncology care services leading the industry in value-based clinical and financial outcomes. OPN currently serves 1.7 million health plan beneficiaries in 3 states. OPN is aggressively expanding its large and successful California business model across the country.\r\n\r\nOPN partners with physicians and aligns their practices with health insurance organizations and other healthcare payors to deliver industry-leading oncology care while managing costs efficiently. OPN has a demonstrated track record in assisting payors to reduce the increasing costs of medical oncology through a value-based methodology.\r\n\r\nOPN Healthcare is committed to creating a diverse environment and is proud to be an equal opportunity employer.\r\n\r\nOPN supports a healthy work life balance and provides a comprehensive benefits package.