Job Description

Prior Authorization, Referral, and Medical Records Coordinator

Department: Clinic Ops

Employment Type: Full Time

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

Reporting To: Hollie Yamashige

Compensation: $20.00 - $22.00 / hour

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

Join Our Team!
The Referrals, Prior Authorizations, and Medical Records Coordinator is responsible for managing the end-to-end coordination of patient referrals, insurance prior authorizations, and medical records processing. This role ensures the timely, accurate, and compliant submission and follow-up of all requests to support seamless patient care and operational efficiency.

The ideal candidate demonstrates a strong sense of urgency, exceptional attention to detail, and the ability to communicate effectively with patients, healthcare providers, and insurance representatives. This position plays a critical role in maintaining continuity of care by ensuring that all required documentation is complete, accurate, and processed efficiently within established timelines.

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