Referral & Prior Auth Rep III

Oversee department referrals and prior authorizations, acting as a liaison between referring offices, specialists, and patients to coordinate scheduled visits and procedures. Prioritize urgent requests using medical protocols, expediting complex cases involving imaging, sleep studies, and non-invasive procedures while managing orders for ED and Urgent Care patients. Communicate with insurance carriers to obtain authorizations, resolve denials through peer-to-peer reviews, and ensure accurate documentation of medical necessity in the electronic health record. Track patient compliance with treatment plans, reconcile discrepancies between departments, and ensure electronic transfer of Summary of Care to referred offices.