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Job description
Referral Specialist
Pittsburgh, PA 15218; PITTSBURGH, PA 15218
Description
* Track and follow up on prior authorization requests after submission, including communication with payers, providers, pharmacies, and patients as needed.
* Coordinate and monitor referrals for diagnostic testing, specialist visits, laboratory orders and results, and ancillary services such as physical therapy, home health care, and durable medical equipment.
* Contact outside facilities, physician offices, and specialty providers to obtain clinical results, visit summaries, consultation notes, and other required documentation.
* Provide or obtain additional clinical information needed to support referral and authorization requests.
* Follow up with patients to support compliance with provider orders and assist with scheduling diagnostics, labs, specialist appointments, or pharmacy-related needs.
* Help close the referral loop by tracking pending referrals, obtaining results or reports, updating the care team, and ensuring documentation is complete in the electronic medical record.
* Communicate professionally with patients, providers, insurance representatives, pharmacies, and external healthcare organizations to resolve delays or barriers to care.
* Maintain accurate, timely, and confidential documentation of referral and authorization activity in accordance with organizational policies and applicable privacy standards.
* Collaborate with clinical and administrative team members to stabilize workflow between prior authorizations, patient referrals, and provider follow-up.
* Perform other related duties as assigned to support patient care coordination and clinic operations.
#LP
Qualifications
POSITION REQUIREMENTS:
Education/Experience
* High school diploma or equivalent required.
* Minimum of 1-2 years of experience in prior authorization, referral coordination, insurance verification, medical office support, or related healthcare administrative work.
* Experience working with electronic medical records or electronic health records.
* Familiarity with Medicare, Medicaid, managed care plans, payer requirements, and authorization workflows.
Skills/Abilities
* Working knowledge of medical terminology, CPT and ICD-10 codes, referral processes, and insurance documentation requirements.
* Strong organizational skills, attention to detail, and ability to follow tasks through to completion.
* Excellent verbal and written communication skills, including professional telephone etiquette.
* Ability to manage multiple priorities in a fast-paced clinical office environment.
* Ability to handle sensitive patient information with professionalism and confidentiality.
Preferred Skills/Abilities
* Certified Medical Assistant credential preferred.
* Experience in a primary care, family practice, community health, or federally qualified health center setting preferred.
* Experience coordinating referrals for diagnostics, specialty care, labs, durable medical equipment, home health care, or physical therapy preferred.
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Who can apply
Review the original listing for work authorization, qualifications and employer requirements.