Referral Center Representative

Full-time position (1.0 FTE) within the Referral and Prior Authorization Management department.

About the role

The Referral Center Representative coordinates patient referrals, schedules specialty exams, obtains insurance pre-authorizations, and ensures accurate documentation to facilitate timely and accurate healthcare access. This role serves as a liaison between patients, healthcare providers, and third-party payers to support seamless communication and care coordination.

Schedule

Monday–Friday, 8:00 AM–5:00 PM

Responsibilities

• Coordinate patient referrals by scheduling appointments and ensuring timely, accurate processing of referral requests; initiate referrals within 24 hours on business days and document all stages in Electronic Medical Records (EMR) systems.
• Schedule specialty exams, diagnostic tests, and outpatient services, ensuring proper authorization and documentation.
• Obtain and document insurance pre-authorizations and approvals from Third-Party Payers (TPP) for required services.
• Track and monitor referrals, ensuring proper documentation and follow-ups for injury cases; maintain accurate referral reports for management.
• Act as a liaison between patients, providers, employers, insurance companies, attorneys, and healthcare facilities to ensure seamless communication, care coordination, and timely notification of appointments and procedure instructions.
• Monitor and distribute incoming faxes, voicemails, and messages, forwarding them to appropriate personnel as required.
• Complete necessary forms and requisitions for referrals and diagnostic testing, ensuring accurate Current Procedural Terminology (CPT) and International Classification of Diseases, 10th Revision (ICD-10) coding for billing and insurance purposes.
• Maintain current knowledge of payer-specific prior authorization requirements by attending virtual workshops and reviewing updates from insurance providers.
• Register patients, verify demographic and insurance information, and assist in scheduling office staff to optimize patient flow.
• Support quality improvement initiatives by tracking referral trends, identifying delays, and implementing workflow optimizations.
• Ensure adherence to Health Insurance Portability and Accountability Act (HIPAA) regulations, maintaining patient confidentiality while handling sensitive information.

Requirements

• High School Diploma or equivalent required.

Benefits

• Paid time off and parental leave.
• 401K matching and employee recognition program.
• Dental and health insurance, paid holidays, short- and long-term disability.
• Pet insurance for four-legged family members.
• Early access to earned wages with Daily Pay.
• Tuition reimbursement and adoption assistance.