Referrals Specialist

TEKsystems•San Diego, CA

3d•$25 - $25•Onsite

About The Position

We are seeking a bilingual Referral Specialist to join a busy pediatric healthcare clinic in San Diego, CA. This individual will play a vital role in supporting patient access to care by coordinating referrals, obtaining insurance authorizations, scheduling specialty services, and maintaining accurate referral documentation. The ideal candidate will have experience working in a healthcare environment, strong knowledge of insurance eligibility and authorization processes, and a commitment to providing exceptional patient service.

Requirements

Fully bilingual in English and Spanish, including verbal and written communication.
Minimum of 1 year of healthcare experience involving referral coordination, authorizations, or both front and back office responsibilities.
Knowledge of insurance plans, eligibility requirements, benefits, and authorization guidelines.
At least 2 years of customer service experience.
Experience utilizing Electronic Medical Records (EMR) systems.
Typing speed of at least 35 words per minute.
High School Diploma or GED.

Nice To Haves

Experience with Epic EMR.
Medical Assistant Certificate or related healthcare training.
Knowledge of coding and data processing practices.
Experience working in a high-volume healthcare or call center environment.
Familiarity with pediatric, specialty clinic, or managed care settings.

Responsibilities

Receive, review, and process referral and authorization requests accurately and efficiently while ensuring complete documentation.
Coordinate and schedule referrals, specialty consultations, diagnostic testing, durable medical equipment (DME), and ancillary services as ordered by providers.
Obtain insurance authorizations through phone, fax, email, payer portals, and other communication channels.
Follow up on outstanding authorization requests and missing documentation to prevent delays in patient care.
Verify patient eligibility, benefits, coverage requirements, and authorization criteria with various insurance plans.
Manage referrals throughout the entire lifecycle, from initiation through completion and closure.
Utilize EMR systems and multiple software applications to document patient information, track referrals, schedule services, and obtain authorizations.
Communicate referral and authorization status updates to patients, providers, and internal healthcare teams.
Review referral logs regularly and update records with appointment details, outcomes, and follow-up requirements.
Confirm patient attendance at scheduled appointments and obtain specialist reports, visit notes, and test results as needed.
Maintain professionalism and excellent customer service when interacting with patients, providers, and healthcare partners.
Consistently meet productivity, quality, and turnaround time expectations.