Outside Referral Coordinator

In this role, you will serve as a vital link between healthcare providers, members, and clinical teams. You will handle inbound calls, gather clinical and administrative details, and process prior authorization requests with accuracy and empathy. Working in a high-volume call management setting (spending 6+ hours of your shift actively assisting callers), you will navigate policy guidelines, verify coverage criteria, and provide real-time updates. The ideal candidate brings reading comprehension, sharp attention to detail, and a dependable, patient-first mindset. Key Responsibilities: Conduct prior authorization intake by phone with providers and members, accurately entering data into EPIC Tapestry UM. Provide prompt, professional status updates on authorization requests while delivering exceptional customer service. Review benefits, coverage criteria, and documentation guidelines across a variety of medical request types. Efficiently manage high-volume call workflows, spending 6+ hours of an 8-hour shift handling live inquiries. Qualifications & Skills: High school diploma or GED required; Associate degree or higher preferred. 3+ years of related experience in healthcare customer service, intake, or prior authorization. Required proficiency with EPIC, Cisco/Finesse phone systems, referral management systems, and MS Outlook. Experience with utilization management (UM), CMS guidelines, and medical terminology or anatomy & physiology preferred. reading comprehension and professional phone etiquette to ensure a positive member experience.

salary: $31.99 - $32 per hour shift: First work hours: 8 AM - 5 PM education: High School

Responsibilities

Conduct prior authorization intake by phone with providers and members, accurately entering data into EPIC Tapestry UM. Provide prompt, professional status updates on authorization requests while delivering exceptional customer service. Review benefits, coverage criteria, and documentation guidelines across a variety of medical request types. Efficiently manage high-volume call workflows, spending 6+ hours of an 8-hour shift handling live inquiries.

Skills

• customer service
• EPIC, Cisco/Finesse
• utilization management

Qualifications

• Years of experience: 3 years
• Experience level: Experienced

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Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.