Referral Specialist - Gerald Family Care
Location: Washington, DC
Job Type: full-time
Company: Aledade
Category: Non-Provider
Job Description Apply Now
Location: Gerald Family CarePosition: Referral Specialist
We Are Hiring a Referral Specialist to Join Our Team!
Our busy family medicine practice, with multiple providers and several practice locations, is seeking a detail-oriented and organized Referral Specialist to join our team. The ideal candidate will have experience in managing patient referrals, handling image prior authorizations, and a deep understanding of insurance portals. You’ll work to ensure that all specialists are within the patient’s insurance network and facilitate timely and accurate prior authorizations for imaging services. This is an essential role in ensuring our patients receive the specialized care and diagnostic testing they need while navigating complex insurance requirements.
Responsibilities:
- Process and manage patient referrals to specialists, ensuring accurate information is provided to both patients and specialists.
- Use insurance portals to verify specialist participation within the patient’s insurance network and ensure correct coding and documentation.
- Coordinate prior authorization requests for imaging services (X-rays, MRIs, CT scans, etc.) in collaboration with physicians and imaging facilities.
- Communicate with insurance companies to resolve any referral-related issues or questions regarding network status, prior authorizations, and coverage.
- Ensure all referral and prior authorization protocols and procedures comply with practice policies, insurance regulations, and patient privacy laws.
- Maintain detailed records of referral requests, prior authorization approvals, imaging results, and outcomes in the practice’s electronic health record (EHR) system.
- Coordinate follow-up appointments for patients and track referral and imaging outcomes to ensure timely care.
- Educate patients about their insurance coverage, co-pays, and any necessary steps to schedule specialist visits or imaging appointments.
- Collaborate with medical providers and administrative staff to ensure referrals and authorizations are handled efficiently and accurately.
Qualifications:
- High School diploma or equivalent; additional certification or education in healthcare administration or related field is a plus.
- Prior experience as a Referral Specialist, Medical Office Coordinator, or in a similar role within a family medicine or multi-provider practice.
- Experience with handling image prior authorizations for diagnostic tests (X-rays, MRIs, CT scans, etc.) and working with insurance companies to obtain approvals.
- Knowledge of various insurance portals and the ability to verify network participation and authorization requirements for specialists and imaging services.
- Strong organizational skills and attention to detail with the ability to multitask in a fast-paced environment.
- Excellent communication skills, both written and verbal, with the ability to work effectively with patients, providers, and insurance companies.
- Proficient in electronic health records (EHR) systems and Microsoft Office Suite.
- Ability to work independently, prioritize tasks, and manage time efficiently.
What We Offer:
- Competitive salary and benefits package.
- Supportive team environment with a focus on patient-centered care.
- Opportunity to work with a dedicated, experienced team of healthcare professionals.
- A chance to make a positive impact on patients' health by ensuring they get the care they need through efficient and accurate referrals and prior authorizations.
How to Apply:
If you’re organized, detail-oriented, and have experience working with insurance portals, referrals, and image prior authorizations, we’d love to hear from you! Please submit your resume and a brief cover letter explaining your experience with insurance networks, prior authorizations, and why you would be a great fit for this role.
We are an equal opportunity employer and encourage applicants from diverse backgrounds to apply.