Prior Authorization, Referral, and Medical Records Coordinator

Department: Clinic Operations

Employment Type: Full Time

Location: 1658 W. Valley Blvd. Suite 120 Alhambra, CA 91803

Reporting To: Hollie Yamashige

Compensation: $20.00 - $22.00 / hour

Description

Job Title: Prior Authorization, Referral, and Medical Records Coordinator Department: Clinic Ops About the Role: The Referrals, Prior Authorizations, and Medical Records Coordinator is responsible for ensuring the timely and accurate submission, follow-up, and approval of referrals and prior authorizations. This role requires a strong sense of urgency, attention to detail, and consistent, high-quality communication with patients, providers, and insurance companies. The coordinator plays a key role in supporting continuity of care by ensuring all required documentation is complete and processed efficiently. What You'll Do: • Ensure timely, accurate submission, follow-up, and approval of referrals, prior authorizations, and medical records while maintaining a high level of urgency and quality. • Communicate effectively with patients, insurance companies, and internal teams regarding authorization status, requirements, and updates. • Review requests for accuracy and completeness, ensuring all required information and supporting documentation are included prior to submission. • Assist with gathering and submitting medical necessity documentation to expedite approvals and ensure compliance with payer requirements. • Perform consistent and appropriate follow-up on all pending authorizations and referrals. • Collaborate with clinical and administrative departments to obtain required information for prior authorizations and to support appeals when necessary. • Document all interactions with insurance companies and/or patients accurately and thoroughly in the system. • Maintain detailed and accurate records of all prior authorization information, including approval dates, billing units, procedure codes, and authorization numbers within the patient profile. • Proactively monitor and manage prior authorizations approaching expiration and initiate renewal processes as needed. • Ensure all medical records requests are processed accurately and in compliance with organizational policies and regulatory standards. • Complete all assigned duties, projects, and reports in a timely manner on a daily, weekly, or monthly basis as directed by leadership. Qualifications: • High school diploma or equivalent required. • Minimum of __1___ year experience in prior authorization, referrals, clinical operations, or related functions • Strong verbal and written communication skills; must be able to communicate in a professional and courteous manner. • Proficient in Microsoft Office applications and insurance eligibility database. • Excellent data entry and typing skills. You're great for this role if: • Knowledge of managed care and medical insurance plans • Knowledge of Elation EHR or similar system • Experience with medications, injections, biologics, and specialty treatment authorizations

Key Responsibilities

Skills, Knowledge & Expertise

• High school diploma or equivalent required; associate degree or healthcare certification preferred
• Prior experience in healthcare administration, referrals, prior authorizations, or medical records strongly preferred
• Knowledge of insurance plans, medical terminology, and authorization processes
• Strong organizational skills with the ability to manage multiple priorities simultaneously
• Excellent written and verbal communication skills
• Proficiency with EHR systems and Microsoft Office applications
• Attention to Detail
• Time Management & Prioritization
• Customer Service Orientation
• Problem Solving & Critical Thinking
• Accountability & Reliability
• Team Collaboration