Role Summary
We are seeking experienced, detail-oriented Referral & Authorization Coordinators to join our growing Cardiology practice. Unlike a general front desk position, this is a dedicated specialist role that owns the complete lifecycle of office visit referrals and prior authorizations—from initial intake to final scheduling and resolution.
Working independently within Epic EMR, you will verify patient insurance eligibility, navigate HMO/PPO authorization rules, coordinate directly with referring provider networks, and keep patients informed throughout the clearance process.
Requirements
Key Responsibilities
- Full Lifecycle Referral Management: Receive, triage, and manage high-volume cardiology referral intakes; track requests from initial receipt through authorization approval and closure.
- Prior Authorization Processing: Submit, track, and secure prior authorizations specifically required for cardiology office visits and specialist consultations in accordance with payer guidelines.
- Insurance Verification & Eligibility: Conduct comprehensive insurance eligibility, copay, coinsurance, and network benefit verifications across Medicare, Medicaid, and commercial carriers (HMO, PPO, POS).
- Provider & Patient Coordination: Communicate efficiently with referring physician offices to obtain missing clinical documentation; reach out directly to patients to outline coverage details and next steps.
- Epic EHR Workqueue Navigation: Maintain daily management of referral workqueues in Epic, ensuring accurate data entry, precise status updates, and meticulous clinical documentation.
- Payer Escalations & Denial Follow-Up: Proactively contact insurance representatives to resolve authorization delays, clarifying medical necessity documentation to prevent service delays.
Highly Preferred Qualifications
- Epic EMR Expertise: Direct hands-on experience using Epic (specifically Referral and Authorization Workqueues).
- Enterprise Background: Experience operating within a large medical group, health system, or enterprise clinical setting.
- Language Skills: Bilingual English/Spanish (required for 2 of the 4 available openings).
- Specialty Experience: Prior experience in a Cardiology practice or multi-specialty group.
- Payer Diversity: Exposure to Medicare Advantage, state Medicaid programs, and major commercial payers.