Referrals and Prior Authorizations Coordinator (Hybrid)

Description We are seeking a proactive and compassionate Prior Authorizations and Referral Coordinator to support patients requiring specialty care. In this role, you will coordinate referrals and prior authorizations by submitting requests through appropriate insurance portals, ensuring timely approvals, and facilitating communication between patients, providers, and specialists. This position requires strong attention to detail, excellent customer service skills, and the ability to manage follow-ups to confirm patients receive the care they need. What You'll Do • Handle a high volume of incoming calls efficiently while addressing patient and provider inquiries regarding prior authorizations. • Identify patients’ needs, clarify information, research issues, and provide solutions related to prior authorization requests. • Provide courteous and professional customer service to patients, providers, and pharmacies regarding prior authorization status and requirements. • Verify insurance eligibility and coverage for prior authorization requests, including prescription medications. • Initiate, prepare, and submit prior authorization requests for medications and specialty treatments to insurance companies. • Follow up on pending medication authorizations, ensuring all required documentation (e.g., clinical notes, formulary guidelines) is provided. • Request and review medical records from other providers as needed to support prior authorization requests. • Communicate with prescribers and pharmacy staff to address prior authorization rejections, alternative medication options, and appeal processes. • Ensure all prior authorization requests are submitted accurately and promptly in accordance with payer guidelines. • Track, document, and maintain records of all prior authorization activities, including approvals, denials, and follow-ups, in the patient’s electronic medical record (EMR). • Educate patients on insurance formularies, step therapy, and medication alternatives if prior authorization is denied. • Maintain up-to-date knowledge of insurance guidelines, coverage policies, and managed care regulations related to medication authorizations. • Additional duties as needed. Qualifications • High school diploma or equivalent required. • One (1) to three (3) years of experience in medical customer service, prior authorizations, or a related field. • Experience with medication prior authorizations, pharmacy benefits, or managed care preferred. • Strong knowledge of insurance coverage policies, formularies, and prior authorization guidelines. • Ability to interpret insurance benefits and explain prior authorization processes to patients and providers. • Strong verbal and written communication skills; must be able to communicate in a professional and courteous manner. • Proficiency in Microsoft Office applications and insurance eligibility databases. • Experience with electronic medical record (EMR) systems such as eClinicalWorks (eCW) is a plus. • Excellent data entry, typing, and organizational skills to track and manage prior authorization requests effectively. Environmental Job Requirements and Working Conditions • This role follows a hybrid work structure where the expectation is to work remotely from home and onsite as needed on a weekly basis, Monday through Friday, standard business hours. This position will be primarily remote with occasional travel to provider offices in the Los Angeles/Orange County area. The home office for this role is located at 1658 W. Valley Blvd. Suite 120 Alhambra, CA 91803. • The total pay range for this role is $22 - $25 per hour. This salary range represents our national target range for this role. Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditionos), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation. Additional Information: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change. Apply tot his job