Medical Records and Referral Specialist

26 Health,Inc•Orlando, FL

7d•$45,000 - $75,000

About The Position

The Medical Records and Referral Specialist at 26Health is responsible for coordinating medical referrals and medical records efficiently and accurately, ensuring patients receive timely care. Additionally, they are responsible for all prior authorization requests based on the requested service. Reporting to the Director of Operations this role serves as a key liaison between healthcare providers, patients, and insurance companies, supporting seamless access to necessary medical services while maintaining professionalism and attention to detail.

Requirements

High school diploma or equivalent required; associate or bachelor’s degree in healthcare, medical administration, or related field preferred.
Minimum 2 years’ experience in medical office administration, referral coordination, or similar healthcare roles.
Familiarity with insurance policies, healthcare terminology, and EHR/medical office software.
Strong organizational skills, attention to detail, and ability to manage multiple tasks in a fast-paced environment.
Excellent communication and interpersonal skills for effective interaction with patients, providers, and insurance companies.
Proficient in Microsoft Office Suite and EHR systems; able to quickly learn new software and tools.

Nice To Haves

Knowledge of medical coding and billing processes is a plus.

Responsibilities

Maintain and update patient health records in the electronic health record (EHR) system
Process medical records requests in accordance with the organizational standard and timeframe.
Retrieve, scan, and upload external records and documents to the appropriate patient charts.
Manage and process patient referral requests, ensuring accuracy, timeliness, and compliance with medical and insurance protocols.
Communicate with patients regarding referral status, appointment scheduling, and follow-up information.
Verify insurance eligibility, network participation, and referral requirements prior to scheduling.
In collaboration with the billing department, assist in resolving insurance or billing issues related to referrals.
Maintain accurate patient referral records and manage medical record requests in the EHR system, ensuring compliance with legal and regulatory standards.
Serve as a liaison between patients, providers, and specialists to facilitate smooth communication and referral progress.
Collaborate with internal staff and external healthcare providers to ensure timely processing of referrals.
Confirms continuity of care for patients by monitoring pending referrals and ensuring specialty services are obtained based on a predetermined basis set by the organization.
Address and resolve challenges in the referral process, including scheduling conflicts or insurance complications
Review medical necessity criteria, payer policies, and clinical documentation for prior authorization requests.
Prepare and submit prior authorization forms, clinical notes, and supporting documentation to insurance companies or managed care organizations.
Communicate authorization approvals, denials, or additional information requests to providers and patients promptly.
Collaborate with clinical staff to obtain any missing documentation or clarify medical necessity.
Monitor and track authorization status to avoid delays in patient care and ensure renewals are processed before expiration.
Document all prior authorization activities and outcomes in the EHR system.
Assist in departmental initiatives meant to improve the continuity of care and patient experience for all patients across the organization.
Perform other duties as assigned.