Referral & Authorization Coordinator - Cardiology Practice

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.