PCP Referral Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Manage a high-volume queue of patients that require referrals from their primary care physicians (PCP) prior to starting cardiac rehabilitation.

• Reach out to PCP offices through phone, fax, portal, and other authorized methods to request and follow up on referrals.

• Ensure timely and consistent follow-up on any outstanding referral requests.

• Verify the status of requests directly with PCP offices.

• Confirm that received referrals include all necessary information and documentation.

• Follow up on referrals that are incomplete, incorrect, unsigned, or otherwise not processable.

• Maintain follow-up until a referral is obtained or a definitive outcome is established.

• Investigate reasons for any delays or incomplete referrals and navigate any barriers presented by PCP offices.

• Document any unresolved referrals and escalate issues when necessary.

• Communicate with patients when their assistance is required.

• Conduct insurance eligibility checks and benefits verification as business needs arise.

• Identify whether prior authorization is necessary and initiate or follow up on authorization requests.

• Engage with insurance plans, provider offices, or other relevant parties to collect required information.

• Keep accurate records of outreach attempts, conversations, statuses, barriers, next steps, insurance benefits, and authorization outcomes.

• Maintain precise records of referrals, insurance, and authorization statuses in designated systems and workflows.

⛳️ Requirements

• A minimum of 3 years of direct experience in obtaining and following up on referrals from PCPs or other physicians.

• Extensive experience in direct communication with PCP offices, medical groups, and clinical staff.

• Strong grasp of healthcare referral workflows and documentation requirements.

• Proven experience managing high-volume referral queues.

• Expertise in troubleshooting delayed, incomplete, rejected, or unsuccessful referrals.

• Exceptional persistence and follow-through, with the ability to make repeated follow-up attempts when necessary.

• Strong phone communication skills and confidence in interacting with front-desk staff, referral coordinators, medical assistants, nurses, and other medical office personnel.

• Excellent organizational and documentation abilities.

• Capability to efficiently prioritize and manage a large volume of outstanding referrals.

• Strong problem-solving skills, with the ability to investigate the reasons behind referral delays.

• Comfort in a fast-paced healthcare environment.

• Experience with Medicare Advantage and commercial insurance referral requirements is highly preferred.

• Previous experience in completing insurance eligibility checks and benefits verification and/or prior authorization checks is strongly preferred.

• Familiarity with obtaining referrals for specialty care, cardiac care, rehabilitation, or other services requiring PCP referrals is highly preferred.

• Experience working with health plans, medical groups, IPAs, or delegated referral processes is strongly preferred.

• Knowledge of payer portals, referral portals, EHRs, fax-based workflows, and insurance verification systems is strongly preferred.

• Background in centralized referrals, prior authorization, patient access, or revenue cycle operations is strongly preferred.

🏝️ Benefits

• No employment benefits included (e.g. health insurance and PTO are not included).