Referral Specialist

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. 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. PI0454e3dfbabd-0973 by Jobble