Referral & Authorization Care Coordinator

Referral and Authorization Coordinator Reports To: Manager, Care Operations Locations Hiring From: Arizona, Delaware, Florida, Georgia, Idaho, Indiana, Louisiana, Missouri, New Hampshire, North Carolina, South Carolina, Tennessee, Texas, Vermont, Virginia ONLY. Must currently reside and plan on residing in the entire employment. Schedule: Monday- Friday 12-8pm EST Employment Type: Full-Time Role Overview As our Care Coordinator specializing in Prior Authorizations & Referrals, you will manage back-office responsibilities including referral management, prior authorizations, specialty pharmacy & infusions, and medical records to help deliver and implement clinical strategies and support member care coordination in collaboration with a multidisciplinary clinical team. You will use a high level of attention to detail, organization, and communication skills to obtain, manage, and follow up on member referrals and prior authorizations to ensure key care plan goals are met. What You'll Do: Key Responsibilities Collaborate with a multidisciplinary team of care providers (including MDs, NPs, RDs, Behavioral Health Providers, and Health Coaches) to provide a whole-person approach to member care. Coordinate, track, and communicate patient referrals, prior authorizations, and medical records to promote team awareness and patient safety. Provide complete and accurate registration of referrals and authorizations, including patient demographics, insurance information, and clinical documentation to external providers and specialty pharmacies. Offer proficient knowledge of referrals, insurance requirements, and the prior authorization process to internal and external resources, eliminating barriers to care and following up on progress toward key goals. Apply knowledge of CPT and ICD-10 codes to obtain authorizations in a timely manner while demonstrating understanding of payer medical policy guidelines. Initiate appeals for denied authorizations and maintain close follow-up to ensure positive member outcomes. Engage in external coordination of pharmacy support services to ensure members receive all necessary support throughout the prior authorization process. Assist members in accessing services, providing personalized customer service while maintaining close communication with the care coordination team. Manage key reports and track relevant data to identify successes and drive refinements in operational processes. What We're Looking For: Qualifications & Requirements Required Minimum of 2-3 years experience in healthcare coordination, care, or case management within a remote digital healthcare space Completed degree in a health and science related field (biology, psychology, health science, nutrition, nursing, etc.). Fluent in healthcare terminology with a working understanding of clinical concepts. Background knowledge navigating health insurance plans and coverage, with ability to provide benefits breakdown analysis to consumers. Comfortable and competent with common administrative technologies (Zoom, Slack, Office or equivalent), charting electronically in EMR/EHR systems Preferred Experience working in telehealth or a digital health environment. Strong critical thinking skills with ability to triage accurately and escalate appropriately. Experience in a high-growth startup or mission-driven healthcare organization. Compensation & Benefits Salary Range: $45,000 – $52,000 (commensurate with experience) Health Benefits: Employer-sponsored medical, dental, and vision coverage Time Off: Unlimited PTO + 11 paid company holidays Retirement: Eligibility to contribute to 401(k) Work Style: Remote-first — work from home anywhere in the US Growth: Tailored professional development opportunities as we scale Life Concierge: Access to Overalls, because we know life happens About Oshi Health Oshi Health is a virtual digestive health practice on a mission to transform GI care. We combine compassionate, multidisciplinary care with innovative technology to help people with chronic digestive conditions get the answers and relief they deserve. When you join Oshi, you're joining a team and a mission that's changing what great healthcare looks like. Oshi Health is revolutionizing GI care with a digital clinic model that provides easy, convenient access to an integrated and multidisciplinary care team that takes a whole-person approach to diagnosing, managing, and treating digestive health conditions. We take time to get to know each patient, develop a personalized, whole-person care plan that includes identification of symptom triggers and prescription of evidence-based interventions, including medications, dietary changes, and mental health support. For Every Oshi Team Member We Want: Genuine passion for improving patient lives and transforming GI care Strong communication skills and emotional intelligence Comfort in a fast-paced, remote-first, mission-driven environment Compensation Range $47,000 — $52,000 USD Note: This job description serves as a general overview and may be subject to change based on organizational needs and requirements. Oshi Health is an equal opportunity employer that is committed to creating a diverse work environment. To do that, we champion a workplace where each and every person is treated with dignity and respect and is valued for their unique perspective and contributions. Oshi Health’s policy is to maintain a working environment that encourages mutual respect, promotes harmonious and congenial relationships between employees, and is free from all forms of discrimination and harassment of any employee (or applicant for employment or service provider) by anyone, including supervisors, co-workers, vendors, or clients. Harassment and discrimination in any manner or form is expressly prohibited. There is no tolerance for discrimination or unequal treatment of any kind on the basis of race, color, religion, creed, gender, sex, sexual orientation, gender identity or expression, pregnancy, sexual and reproductive health decisions, national origin, age, disability, genetic information, marital status or civil partnership/union status, familial status, military or veteran status, predisposition or carrier status, domestic violence victim status, alienage or citizenship status, unemployment status, sexual violence or stalking victim status, caregiver status, or any other characteristic protected by law. This practice applies to all terms, conditions and privileges of employment including, but not limited to, recruitment, selection, promotion, demotion, transfer, layoff, rehire, termination of employment, development and training, compensation, benefits and retirement. For more information, visit us at www.oshihealth.com Oshi Health will never contact job candidates via text message or any other messaging platform including WhatsApp, Signal, and Telegram. All official correspondence will occur through email. We will never ask you to share bank account information, cash a check from us, or purchase software or equipment as part of your interview or hiring process. If you have concerns, please reach out to [email protected] , and we’ll confirm whether you’re engaging with one of our Oshi teammates!