Referral & Prior Auth Rep III
Core
Manages department referrals, coordinates patient appointments, and secures insurance prior authorizations for cardiac rehab and specialty services.
Role type
Senior administrative coordinator (referrals & prior auth)
Builds
Patient care pathways and insurance approval workflows
Domain
Healthcare administration / Cardiac rehabilitation
Required skills
Medical terminology, Electronic Health Records (EHR) management, Insurance authorization protocols, Data analysis, Patient advocacy, Scheduling coordination
Preferred skills
Surgical scheduling software, Peer-to-peer review processes, ICD/CPT coding knowledge
Responsibilities
Manage department referrals and coordinate scheduled visits; Acquire insurance authorizations for visits and testing; Prepare complex details for insurance carriers to obtain prior approvals; Process incoming and outgoing referrals; Track patient compliance with treatment plans; Resolve insurance denials and coordinate peer-to-peer reviews.
Seniority
Mid-level, hands-on coordinator