Referral & Prior Auth Rep III
Core
Manages department referrals, coordinates patient appointments, and secures insurance prior authorizations for medical procedures and imaging.
Role type
Senior administrative specialist (referral and prior authorization)
Builds
Patient care pathways and insurance approval workflows
Domain
Healthcare administration / Medical billing
Required skills
Medical terminology, insurance policy knowledge, ICD/CPT coding, electronic health record management, data analysis, patient advocacy
Preferred skills
Surgical scheduling software experience, complex appointment scheduling, peer-to-peer review coordination
Responsibilities
Manage department referrals and coordinate scheduled visits; Acquire insurance authorization for visits and testing; Prepare and submit prior authorization requests to carriers; Resolve claim denials and coordinate peer-to-peer reviews; Process incoming and outgoing referrals; Manage orders for patients in ED/Urgent Care.
Seniority
Mid-level, hands-on IC