Medical Referral & Prior Authorization Specialist
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- English
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AdventHealth Well65+ —Altamonte Springs, FL
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Medical Referral & Prior Authorization Specialist

Invested Health Center, Inc.
Orlando, FL

Apply Now

Job Details

Full-time
$25 - $32 an hour

Benefits

Paid holidays
Dental insurance
Paid time off
Vision insurance

Qualifications

Availity
Collaborate with healthcare professionals
Spanish
Overseeing health insurance pre-certification
English
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

This is a fully in-office position at our Orlando location. Remote and hybrid work are not available.

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

Apply Now

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