Referral & Authorization Coordinator - Cardiology Practice

Staffing for Doctors; Philippines; On-site; PHP 300,000 - 420,000; Full time

Job summary

Staffing for Doctors in the Philippines is seeking experienced Referral & Authorization Coordinators to own the complete lifecycle of cardiology referrals and prior authorizations. You will work independently in Epic EMR, verifying eligibility and navigating payer rules while coordinating with referring networks and patients.

The role requires strong communication, meticulous documentation, and proactive issue resolution to prevent delays in care and scheduling.

Qualifications

• Experience handling referrals and prior authorizations in a cardiology setting.
• Proficiency with Epic EMR and payer rules.
• Excellent communication with providers and patients.
• Bilingual English/Spanish preferred for openings.

Responsibilities

• Full Lifecycle Referral Management: Receive, triage, and manage cardio referrals from intake to authorization closure.
• Prior Authorization Processing: Submit, track, and secure authorizations per payer guidelines.
• Insurance Verification & Eligibility: Verify Medicare/Medicaid and commercial plan eligibility and benefits.
• Provider & Patient Coordination: Communicate with referring offices and patients about coverage and next steps.
• Epic EHR Workqueue Navigation: Manage referral workqueues with accurate data entry and status updates.
• Payer Escalations & Denial Follow-Up: Contact insurance to resolve delays and clarify medical necessity.

Skills

Attention to detail

Communication

Bilingual English/Spanish

Tools

Epic EMR

Epic Referral & Authorization Workqueues

Job description

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.