Outside Referral Coordinator

Outside Referral Coordinator

Location: Renton, Washington (Onsite)

Role Overview

We are seeking an Outside Referral Coordinator to manage requests for outside medical care. This role serves as a key contact for providers and members, requiring significant time on the phone to handle inquiries. The position involves gathering information, entering details into the EPIC Tapestry UM System, and communicating prior authorization status. The ideal candidate is reliable and can adapt in a dynamic environment where they will spend a substantial portion of the day in call management.

Key Responsibilities

• Conduct prior authorization intake by gathering required information from providers and members over the phone and accurately entering details into the EPIC Tapestry UM System.
• Review and communicate prior authorization status information, providing updates to callers while maintaining a high level of customer service.
• Apply detailed processing guidelines to support administrative prior authorization workflows, including reviewing benefits, coverage criteria, and documentation requirements.
• Verify patient eligibility, coverage, benefits, and provider status to ensure compliance.
• Manage and adapt to frequent changes while handling multiple tasks efficiently.

Required Qualifications

• A high school diploma or GED is required.
• A minimum of three years of related experience.
• Experience with FINESSE/CISCO phone systems, EPIC, Referral management Systems, and Microsoft products including Outlook.
• Knowledge of CPT and ICD-9/10 coding.
• Professional communication and phone etiquette.
• Efficient call handling skills, with the ability to guide callers through the intake process.
• Strong reading comprehension to interpret written information, policies, and documentation.
• Familiarity with medical terminology.

Preferred Qualifications

• An Associate's degree or higher.
• A medical background in a front or back office, billing, or claims setting.
• Experience in utilization management, CMS requirements, and other regulatory guidelines governing prior authorization.
• Experience with claims processing or other insurance carrier operations.
• A certification or college credits in Medical Terminology and/or Anatomy & Physiology.

Work Environment

• This is an onsite position.
• The expected shift is 8:00 AM to 5:00 PM, Monday through Friday.
• Free parking is available, and the campus is located near mass transit options.
• The dress code is business casual.

Everforth Apex is a world-class IT services company that serves thousands of clients across the globe. When you join Everforth Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRateds Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico.

Everforth Apex uses a virtual recruiter as part of the application process. Click here for more details. By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from Everforth Apex and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy at

Everforth Apex Benefits Overview: Everforth Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Everforth Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Everforth Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Everforth Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our 'Welcome Packet' as well, which an Everforth Apex team member can provide.

Everforth Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Everforth Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law.

If you require an accommodation under the Americans with Disabilities Act to participate in an interview with a virtual recruiter or to use our website for a search or application, please contact our Benefits Department at [email protected] or View phone number on click.appcast.io. Please note that this contact information is strictly to be used for medical ADA accommodations and that no other inquiries will be answered.

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