Medical Referral & Prior Authorization Specialist

Medical Referral & Prior Authorization Specialist Invested Health Center, Inc. Orlando, FL Job Details Full-time $25 - $32 an hour 17 hours ago Benefits Paid holidays Dental insurance Paid time off Vision insurance Qualifications Collaborate with healthcare professionals Spanish Overseeing health insurance pre-certification English Healthcare referral management Portuguese Patient interaction Health insurance referral requirements Documentation review Full Job Description Invested Health Center is seeking an experienced Medical Referral & Prior Authorization Specialist to take ownership of our referral and insurance authorization process. This role is ideal for someone with extensive experience using Availity and payer portals who can independently manage complex prior authorizations, coordinate specialty referrals, and work closely with providers to ensure patients receive timely access to care. About Invested Health Center, Inc. At Invested Health Center, we're Redefining Healthcare for All by delivering Healthcare with Heart. We are a rapidly growing nonprofit healthcare organization providing comprehensive primary care for patients of all backgrounds, while also offering specialized expertise in HIV prevention and treatment, sexual health, preventive medicine, and other innovative healthcare services. Our mission is to expand access to exceptional, compassionate healthcare—especially for individuals and communities who have historically faced barriers to care. We believe healthcare should be personal, respectful, and never rushed. That's why we intentionally schedule longer appointment times so our providers can truly listen, educate, and build lasting relationships with every patient. We focus on delivering the highest quality care—not simply seeing the highest number of patients—and our growth through word-of-mouth referrals is a reflection of the trust we've earned within our community. As we continue expanding our services and reaching more communities throughout Central Florida, we're looking for exceptional people who share our commitment to clinical excellence, innovation, and service. Whether it's providing comprehensive primary care, advancing HIV prevention, introducing new specialty services, or improving access for underserved populations, every member of our team plays a vital role in helping us transform healthcare. If you're looking for more than just a job—if you want to be part of an organization that's improving lives, strengthening communities, and building the future of patient-centered healthcare—we'd love to meet you. Description Position Summary The Medical Referral & Prior Authorization Specialist is responsible for independently managing the clinic's referral and insurance authorization process to ensure patients receive timely access to diagnostic testing, specialty care, medications, and procedures. This position requires significant prior authorization experience and the ability to navigate multiple insurance payer portals while collaborating closely with providers, nursing staff, and medical assistants to obtain the documentation necessary for approval. This is not an entry-level administrative position. We are seeking an experienced professional who understands insurance authorization workflows and can confidently take ownership of this critical function. Key Responsibilities Prior Authorizations Manage prior authorizations for: Advanced imaging (CT, MRI, PET, etc.) Medications Infusion therapies Procedures Specialty services HRA and anal manometry procedures Submit requests through Availity and payer portals Monitor pending requests and proactively follow up Coordinate peer-to-peer reviews and appeals when necessary Maintain accurate authorization documentation within Athena EHR Referral Coordination Process specialty referrals efficiently Coordinate referrals with specialists and diagnostic facilities Track referral completion Obtain consultation notes and reports Ensure timely follow-up on outstanding referrals Clinical Collaboration Work directly with providers, nurses, and medical assistants to obtain supporting documentation Review clinical documentation prior to submission to improve approval success Identify missing information before submitting requests Communicate authorization status to the clinical team Workflow & Process Improvement Help develop efficient authorization workflows Monitor authorization turnaround times Identify opportunities to reduce denials and delays Maintain organized tracking systems for outstanding referrals and authorizations Required Qualifications Minimum 3 years of recent experience processing medical referrals and prior authorizations in a physician practice or specialty clinic Extensive experience using Availity and other insurance payer portals Experience obtaining authorizations for: Imaging Procedures Medications Specialty medications Strong understanding of insurance plans, eligibility, medical necessity requirements, and authorization guidelines Experience working directly with providers to obtain supporting clinical documentation Excellent organizational and follow-up skills Strong written and verbal communication skills Fluent in English and Spanish Preferred Qualifications Experience with Athena EHR Experience with Florida Blue, UnitedHealthcare, Aetna, Cigna, Humana, Medicare, and Florida Medicaid Experience processing appeals and coordinating peer-to-peer reviews Experience in primary care or specialty practice Familiarity with HIV, infectious disease, gastroenterology, cardiology, neurology, or other specialty practices Portuguese language skills are a plus What We're Looking For We're looking for someone who: Takes ownership of their work Is highly organized and detail-oriented Enjoys solving complex insurance challenges Communicates professionally with patients and insurance representatives Works collaboratively with providers and clinical staff Thrives in a fast-paced medical environment Wants to help build scalable processes as our organization continues to grow Why Join Invested Health Center? Be part of one of Central Florida's best nonprofit healthcare organizations Help patients access life-changing care without unnecessary delays Work in an inclusive, supportive, and mission-driven environment Competitive compensation based on experience PPO Health, Dental & Vision Insurance Paid Time Off Paid holidays Opportunities for professional growth as the organization expands We Appreciate Your Interest We appreciate all applicants; however, due to the high volume of applications, only candidates whose qualifications and experience closely match our requirements will be contacted. Salary $25 - $32 per hour