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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