Referrals Specialist

📋 Description

• Request and obtain PCP referrals for patients prior to scheduled appointments for both the
• Submit, track, and follow up on HMO authorization requests for new and established patients until a
• Monitor upcoming appointments to identify referral and authorization requirements in advance and
• Communicate with PCP offices, insurance companies, and patients to resolve missing, expired, or
• Enter and track all referral and authorization activity in the clinic’s referral tracking
• Notify the front desk, scheduling team, and clinical staff when authorizations are pending

🎯 Requirements

• High school diploma or equivalent required; additional education or certification preferred.
• Prior experience in a medical office setting, preferably in referral coordination, prior
• Working knowledge of HMO and PPO plan structures, referral requirements, and authorization
• Knowledge of new patient and follow-up CPT codes, including how they relate to referral and
• Experience with an EMR system and payer portals such as Availity preferred.
• Strong attention to detail and organizational skills, with the ability to track multiple open