Referral Specialist (Full-time, Days)

Responsibilities

• Coordinate scheduling for diagnostic imaging, specialty testing, and physician referrals, including MRI, CT, Neurology, Pain Management, and other specialized services.
• Obtain insurance authorizations and pre-certifications by submitting required clinical documentation and working directly with insurance carriers.
• Review physician orders and medical documentation to ensure accuracy and completeness prior to scheduling.
• Verify appropriate procedure and diagnosis codes needed for authorization requests.
• Communicate with physicians, patients, healthcare facilities, and insurance companies to coordinate timely care.
• Notify patients of scheduled appointments, testing instructions, preparation requirements, and arrival times.
• Document all authorization information, patient communications, and payer interactions accurately within the electronic medical record (EMR).
• Aid self-pay and out-of-network patients by connecting them with appropriate financial resources.
• Maintain current knowledge of scheduling workflows, insurance authorization requirements, and departmental policies and procedures.
• Operate standard office equipment and utilize electronic systems, including EMR software, telephones, printers, copiers, and fax machines.
• Deliver exceptional customer service by greeting and assisting patients professionally in person and by telephone.
• Support continuous process improvement and perform additional duties as assigned to promote efficient practice operations.

Requirements

• High school diploma or GED required.
• Minimum of one year of experience in a healthcare, medical office, scheduling, registration, or insurance authorization environment preferred.
• Proficiency with Microsoft Office applications, including Word and Excel, and the ability to navigate multiple computer systems.
• Strong organizational, communication, and customer service skills.
• Ability to multitask, prioritize competing responsibilities, and work efficiently in a fast-paced environment.
• Strong attention to detail and accuracy when working with patient records, insurance information, and scheduling.
• Ability to maintain confidentiality and exercise professionalism when interacting with patients, providers, and staff.

Preferred Qualifications

• Associate degree in a healthcare-related field.
• Experience obtaining insurance authorizations and pre-certifications.
• Knowledge of medical terminology. Orthopedic terminology experience strongly preferred.
• Experience working with electronic medical records (EMR/EHR).
• Experience working with diagnostic imaging, specialty testing, and referral coordination.
• Experience working with insurance carriers, payer requirements, and medical necessity documentation.