Referral Specialist

• Process insurance pre-authorizations for primary and specialty service visits and testing
• Gather information from patients, providers, insurance carriers, and staff to confirm financial obligations
• Act as liaison between clinical staff, health plans, providers, and patients
• Verify insurance coverage and obtain required authorizations
• Document referral information, communications, actions, and authorization progress in electronic medical systems
• Process internal, external, and outbound referrals through electronic medical records
• Assemble, research, and triage patient demographic, insurance, and medical information
• Track referrals and maintain detailed documentation to promote team awareness and patient safety
• Route inbound referrals according to regulatory and specialty department requirements
• Coordinate prior-authorization details for visits and procedures
• Coordinate provider peer-to-peer interactions for insurance approvals
• Generate cost estimates and direct patients to financial counseling resources
• Contact insurance representatives or contracted review organizations and present medical information
• Advocate for patients to obtain timely approval of necessary services
• Collaborate with Patient Service Representatives, Clinical Staff, and Payer Relations
• Provide documentation for denials and appeals
• Use insurance platforms and medical records systems for accurate data entry, retrieval, and reporting
• Meet performance standards and volume metrics while aligning with organizational values

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