Prior Authorization Specialist | EPIC / Referral Management

Pyramid Consulting Healthcare; Seattle (WA); On-site; USD 40,000 - 41,000; Full time

Benefits offered by this job

Travel benefits

Job summary

Pyramid Consulting Healthcare seeks an experienced Prior Authorization Specialist to manage EPIC Tapestry UM and referral management in Seattle, onsite. This 12+ month contract offers benefits aligned with agency packages and a competitive hourly rate.

Responsibilities include handling high-volume calls, collecting authorization information, and ensuring accurate documentation while complying with CMS guidelines and medical terminology. Previous EPIC experience is required.

Qualifications

• 3+ years in healthcare authorization, referral coordination, or medical administration.
• Experience with EPIC Tapestry UM or EPIC systems.
• Strong communication and data-entry accuracy.

Responsibilities

• Handle high-volume calls from providers, members, and internal teams.
• Collect and document information for prior authorization requests.
• Process and update authorizations in EPIC Tapestry UM and referral management systems.
• Review benefit information, coverage criteria, and supporting documentation.
• Communicate authorization statuses and required items to stakeholders.
• Investigate authorization delays, denials, and related issues.
• Identify requests needing escalation or clinical review.
• Apply processing guidelines and maintain documentation.
• Follow regulatory, compliance, and organizational requirements.
• Deliver timely, accurate service across multiple requests.

Skills

Phone communication

Customer service

Call-handling

Data entry

Attention to detail

Healthcare terminology

CMS guidelines

ICD-10 CPT HCPCS

Education

High School Diploma or GED

Tools

EPIC Tapestry UM

Finesse/Cisco phone systems

Job description

Immediate need for a talented Prior Authorization Specialist | EPIC / Referral Management. This is a 12+ Months Contract opportunity with long-term potential and is located in Seattle, WA (Onsite).

Job ID:26-32024

Pay Range: $29 - $30/hour. Traveler benefits as per agency package. (Benefits vary by vendor and assignment.)

Key Responsibilities:

• Manage high-volume incoming calls from healthcare providers, members, and internal teams.
• Collect and document information required for prior authorization requests.
• Process and update authorization requests in EPIC Tapestry UM and referral management systems.
• Review benefit information, coverage criteria, and supporting documentation.
• Communicate authorization status updates and explain outstanding requirements.
• Research authorization delays, denials, and related administrative issues.
• Identify requests requiring escalation or additional clinical review.
• Apply established processing guidelines and maintain accurate documentation.
• Follow applicable regulatory, compliance, and organizational requirements.
• Deliver professional, timely, and accurate service while managing multiple requests.

Key Requirements and Technology Experience:

• High School Diploma or GED.
• Related healthcare, insurance, authorization, referral coordination, or medical administration experience; 3+ years preferred.
• Strong telephone communication, customer service, and call-handling skills.
• Experience with healthcare computer systems and Microsoft Office, including Outlook.
• Excellent reading comprehension, data entry accuracy, and attention to detail.
• Ability to manage a high volume of calls while maintaining service quality.
• EPIC Tapestry UM or other EPIC experience.
• FINESSE or Cisco phone systems.
• Healthcare benefits, eligibility, and coverage review.
• CMS guidelines, Medicare requirements, and medical terminology.
• Familiarity with ICD-10, CPT, and HCPCS.

Our client is a leading Healthcare and managed care Industry and we are currently interviewing to fill this and other similar contract positions.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.