Referral Specialist

About the Role

As a Referral Specialist, you support a positive patient experience by efficiently processing requests for referrals, prior authorizations, and diagnostic imaging. We value the families we serve, our communities, and our team members.

Responsibilities

• Facilitates outgoing referral requests which include obtaining prior authorization when necessary.
• Obtains prior authorization for patient medications.
• Schedules and obtains prior authorization for diagnostic imaging requests.
• Meets position requirements and performs essential functions.
• Completes all mandatory training as required.
• Performs other duties as assigned.

Qualifications

• High school diploma or equivalent required; associate or bachelor's degree preferred.
• Minimum 1–2 years of credentialing experience, preferably in a pediatric or outpatient healthcare setting.
• Knowledge of credentialing processes, insurance payers, and regulatory standards (e.g., CAQH, Medicare, Medicaid).
• Strong organizational skills with high attention to detail.
• Excellent written and verbal communication skills.
• Proficiency with credentialing software, Microsoft Office (Word, Excel, Outlook), and practice management systems.
• Ability to work independently and manage multiple deadlines simultaneously.

Working Conditions

• Indoor, temperature controlled, smoke free environment.
• May at times work under stressful situations.
• Handicapped accessible.