Referral Specialist

Referral Specialist (Hybrid)

The Authorization & Scheduling Coordinator is responsible for coordinating and scheduling diagnostic testing, specialty procedures, and referrals while obtaining the necessary insurance authorizations and pre-certifications. This role serves as a key liaison between patients, providers, insurance companies, and healthcare facilities to ensure timely access to care. The coordinator maintains accurate documentation in the electronic medical record (EMR), communicates testing instructions to patients, and promotes an exceptional patient experience through outstanding customer service and attention to detail.

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).

Assist 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.

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.

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).

Familiarity with diagnostic imaging, specialty testing, and referral coordination.

Experience working with insurance carriers, payer requirements, and medical necessity documentation.

S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations.

PAY RANGE: $19.00 - $24.00

CITY: Rochester

POSTAL CODE: 14625

The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.

Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.