Healthcare Referral/Prior Authorization 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.

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POSITION REQUIREMENTS:

High school diploma or equivalent required.
Minimum of 12 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.
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