Referral Specialist
Location: Washington, DC
Job Type: Direct Hire
Company: Gerald Family Care Pc
Category: Non-Provider
Job Description Apply Now
Referral Specialist Position OverviewGerald Family Care is seeking a dedicated Referral Specialist to join our dynamic team in a full-time position. As a key member of our family medicine practice, the Referral Specialist will play a crucial role in coordinating patient referrals, managing prior authorizations for imaging services, and facilitating efficient communication between patients, providers, and insurance companies. This role is essential for ensuring patients receive timely access to specialized care while navigating the complexities of insurance networks and authorization requirements.
Key Responsibilities- Process and manage patient referrals to specialists, ensuring all information is accurate, thorough, and communicated efficiently to both patients and providers.
- Utilize insurance portals to confirm specialist participation within patient insurance networks, ensuring correct coding and documentation for all referrals.
- Coordinate and submit prior authorization requests for imaging services, including X-rays, MRIs, and CT scans, in collaboration with physicians, imaging centers, and insurance carriers.
- Communicate directly with insurance companies to resolve referral or authorization issues, verify network status, and clarify coverage details as needed.
- Maintain strict compliance with practice policies, insurance regulations, and patient privacy laws during all referral and authorization processes.
- Document all referral requests, prior authorization approvals, imaging results, and outcomes within the electronic health record (EHR) system accurately and promptly.
- Coordinate follow-up appointments as needed, tracking referral and imaging outcomes to ensure continuity and timeliness of patient care.
- Educate patients about insurance coverage, co-pay responsibilities, and the steps needed to schedule specialist or imaging appointments.
- Work collaboratively with medical providers and administrative staff to support efficient, accurate handling of all referrals and authorizations.
- High school diploma or equivalent required; additional education or certification in healthcare administration or a related field is a plus.
- Previous experience as a Referral Specialist, Medical Office Coordinator, or similar role in a healthcare or multi-provider practice environment.
- Demonstrated expertise in handling image prior authorizations for diagnostic procedures and working with insurance companies to obtain approvals.
- Strong knowledge of insurance portals, including the ability to verify participation, coverage, and authorization requirements for specialists and imaging services.
- Exceptional organizational skills, keen attention to detail, and ability to manage multiple tasks in a fast-paced medical office setting.
- Excellent written and verbal communication skills for effective interaction with patients, providers, and insurance representatives.
- Proficiency in electronic health records (EHR) systems and Microsoft Office applications.
- Ability to work independently, prioritize workload, and manage time effectively.
- Be part of a supportive team dedicated to delivering patient-centered care in a collaborative environment.
- Opportunity to work alongside experienced healthcare professionals committed to excellence.
- Make a positive impact on patient health by ensuring they receive essential specialty care and diagnostic services efficiently and accurately.
Gerald Family Care is proud to serve the community, offering a positive work environment and opportunities for professional growth. Working in this region provides access to a vibrant community and a rewarding healthcare setting.
Equal Opportunity Employer StatementWe are an equal opportunity employer and encourage applicants from diverse backgrounds to apply.