Prior Authorization Specialist - EPIC & Referral Mgmt

Pyramid Consulting Healthcare; Seattle (WA); Sur place; USD 40 000 - 41 000; Plein temps

Avantages offerts par ce poste

Travel benefits

Résumé du poste

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.

Responsabilités

• 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.

Connaissances

Phone communication

Customer service

Call-handling

Data entry

Attention to detail

Healthcare terminology

CMS guidelines

ICD-10 CPT HCPCS

Formation

High School Diploma or GED

Outils

EPIC Tapestry UM

Finesse/Cisco phone systems

Description du poste

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.