Job description
This is a remote position.
Only LATAM-based candidates (bilingual in Spanish and English)We are hiring an experiencedPre-Authorization & Referral Coordinatorto support a fast-pacedU.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 anIndependent Contractoropportunity.
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
Who can apply
Eligible countries: United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.