Referral Care Specialist

Referral Specialist
Hyannis, Massachusetts, United States
This candidate should be local to the Cape 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