Referral Specialist

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

📋 Description

• Handle insurance pre-authorizations for primary and specialty service appointments and tests.

• Collect information from patients, healthcare providers, insurance companies, and staff to verify financial responsibilities.

• Serve as a point of contact between clinical personnel, health plans, providers, and patients.

• Confirm insurance coverage and secure necessary authorizations.

• Record referral details, communications, actions, and the progress of authorizations in electronic medical systems.

• Manage internal, external, and outbound referrals through electronic medical records.

• Compile, investigate, and organize patient demographic, insurance, and medical information.

• Monitor referrals and maintain thorough documentation to enhance team awareness and patient safety.

• Direct inbound referrals according to regulatory and specialty department guidelines.

• Organize prior-authorization specifics for visits and procedures.

• Facilitate provider peer-to-peer discussions for insurance approvals.

• Create cost estimates and guide patients to financial counseling resources.

• Communicate with insurance representatives or contracted review organizations and present medical information.

• Advocate for patients to ensure timely approval of essential services.

• Collaborate with Patient Service Representatives, Clinical Staff, and Payer Relations.

• Provide documentation for denials and appeals.

• Utilize insurance platforms and medical records systems for accurate data entry, retrieval, and reporting.

• Achieve performance standards and volume metrics while adhering to organizational values.

⛳️ Requirements

• Proficient in computer skills to ensure accuracy and promptness.

• Capability to work effectively with colleagues and patients.

• Ability to collaborate with multiple teams.

• Skill in writing clearly and professionally.

• Thorough, precise, and detail-oriented work approach.

• Familiarity with Microsoft Word, Outlook, Excel, and OneNote.

• Preferred knowledge of medical terminology.

• Experience with electronic medical records systems (EPIC) preferred.

• Background in CNA, MA, EMT, healthcare, or health plan preferred.

• Prior experience in referral coordination is preferred.

• Bilingual in Spanish is preferred.

• Capability to meet physical demands, including frequent computer usage, communication, lifting, walking, and transporting patients or supplies.

• Availability to work Monday–Friday during business hours.

• Must reside outside California, Connecticut, Hawaii, Illinois, Massachusetts, Minnesota, New York, Pennsylvania, Rhode Island, Vermont, Virginia, and Washington.

🏝️ Benefits

• Eligibility for benefits.

• Comprehensive benefits package that includes wellness, health, security, connection, and engagement programs.

• Flexible work options where permitted and outlined in the job posting.

• Company-provided equipment and remote-work support as referenced in remote work expectations.