Referral Specialist

Referral Specialist

Burlington, Massachusetts, United States

This candidate should be local to the MA area and willing to travel on a monthly basis.

Overview

The Referral Specialist is responsible for securing all required referrals and insurance authorizations for patients with upcoming appointments at The Vascular Care Group. This role serves as the primary liaison between patients, referring providers, and insurance carriers to ensure that every patient arrives for their visit with the appropriate documentation in place. The Referral Specialist supports continuity of care, minimizes appointment delays and denials, and contributes to a smooth, patient-centered experience by proactively managing the referral pipeline.

The role is non-exempt.

Responsibilities

• Review upcoming appointment schedules daily to identify patients who require referrals or insurance authorizations prior to their visit
• Obtain referrals from primary care physicians and referring providers for all scheduled office visits, diagnostic studies, and procedures
• Submit and follow up on insurance prior authorization requests for office visits, ultrasound and vascular lab studies, interventional procedures, and surgeries
• Verify patient insurance eligibility and benefits to determine referral and authorization requirements specific to each payer
• Communicate directly with referring physician offices to request missing referrals and provide any clinical documentation needed to support the request
• Contact patients to inform them of referral status, request assistance in obtaining referrals from their PCP when needed, and reschedule appointments if a referral cannot be secured in time
• Document all referral and authorization activity, including reference numbers, approval dates, valid date ranges, and approved visit counts, in the patient's electronic medical record
• Track pending referrals and authorizations and escalate issues that may delay patient care to the Office Manager or clinical team
• Coordinate with clinical staff, schedulers, and billing to ensure referral information is accurate and aligned with the services being rendered
• Respond to insurance denials related to missing or invalid referrals and submit retro-authorization requests when appropriate
• Maintain up-to-date knowledge of referral and authorization requirements for Medicare, Medicaid, and commercial payers
• Protect patient rights by maintaining medical, personal, and financial confidentiality
• Ensure compliance with all HIPAA regulations
• Complete ad hoc projects as requested

Requirements

• Minimum of High School diploma, associate or bachelor's degree preferred
• 1+ years of experience obtaining insurance referrals and prior authorizations in a medical setting required; vascular, cardiology, or surgical specialty experience preferred
• Working knowledge of Medicare, Medicaid, and commercial insurance referral and authorization requirements
• Familiarity with electronic medical records and payer portals
• Knowledge of medical terminology and CPT/ICD-10 coding sufficient to support authorization requests
• Knowledge of multi-line phone systems
• Must be able to maintain a professional demeanor in a fast-paced environment
• Excellent communication skills, both verbal and written, with strong attention to detail and follow-through
• Previous experience with Microsoft Office suite
• Ability to perform multiple tasks in a busy medical setting
• Knowledge of and compliance with HIPAA regulations
• Willing to be available for local and/or regional assignments as needed

Compensation

$25/hour - $30/hour. Negotiable based on skills and experience.