Healthcare Referral Coordinator (Medication Authorization)

Overview

Healthcare Referral Coordinator (Medication Authorization) Jobs in Karachi Division, Sindh, Pakistan at MacCare

Title: Healthcare Referral Coordinator (Medication Authorization)

Company: MacCare

Location: Karachi Division, Sindh, Pakistan

Job Summary:

We are seeking a detail-oriented Authorization & Referral Specialist to support patient referral and medication authorization processes. This role is responsible for coordinating referrals, obtaining medication prior authorizations, managing denials and appeals, and communicating with patients, providers, pharmacies, and insurance companies. The ideal candidate will ensure timely processing, accurate documentation, and seamless patient access to care and prescribed therapies. This position plays a key role in delivering positive patient experience and supporting continuity of care.

Key Responsibilities:

Referral Coordination:

• Process incoming and outgoing patient referrals in a timely and accurate manner.
• Ensure all required documentation is complete and submitted to appropriate specialists or healthcare service providers.
• Verify insurance eligibility and obtain prior authorizations as needed for referred services.
• Maintain accurate records in referral tracking systems and electronic health records (EHR).

Prior Authorization Management:

• Submit and manage medication prior authorizations for specialty and non-specialty medications.
• Utilize platforms such as CoverMyMeds, Optum Rx, Express Scripts, CVS Caremark, and payer portals.
• Verify pharmacy benefits, coverage requirements, and authorization criteria.
• Gather and submit required clinical documentation to support authorization requests.
• Follow up with insurance carriers, pharmacies, providers, and patients regarding authorization status.
• Track and manage approvals, denials, renewals, appeals, formulary exceptions, and tier exception requests.
• Maintain accurate documentation and records within EHR and authorization tracking systems.
• Ensure timely processing and resolution of authorization requests to support patient access to therapy.

Patient & Provider Communication:

• Communicate with patients to explain referral steps, answer questions, and provide updates as needed.
• Coordinate with primary care providers, specialists, and clinical teams to ensure continuity of care.
• Serve as a point of contact for referral-related inquiries from patients and healthcare staff.

Administrative Support & Compliance:

• Ensure all referral processes adhere to HIPAA and organizational confidentiality standards.
• Monitor referral queues and follow up on outstanding or incomplete referrals.
• Support continuous improvement efforts by identifying inefficiencies or common issues and escalating them to the lead or supervisor.

Qualifications:

• Education: High school diploma or equivalent required; associate degree or healthcare-related certification preferred.
• Experience: 1–2 years in a healthcare setting with experience in referral coordination, medical front office, or patient services preferred.
• Skills:
• Familiarity with medical terminology and healthcare systems.
• Strong organizational and time-management skills.
• Excellent interpersonal and communication skills.
• Proficiency with EHR systems, referral platforms, and scheduling software.
• Ability to work independently while following established procedures.