Pediatrics - Referral Specialist

Ridgecrest Regional Hospital•Ridgecrest, CA

2d•Onsite

About The Position

The Referral Specialist supports the RRH Pediatrics Department by managing pediatric patient referrals and prior authorization requests. The role ensures referrals are processed accurately and on time, helps navigate insurance requirements, and supports families and clinical teams throughout the referral process. It requires strong customer service, attention to detail, initiative, and confidence with insurance documentation and communication. The position works closely with pediatric and administrative teams to support timely referrals and a collaborative work environment.

Requirements

High school diploma or equivalent.
At least three years of experience in medical insurance or a related field.
Familiarity with prior authorization and referral processes for diagnostics, therapies, and procedures.
Computer proficiency, including Microsoft Word and Excel.
Typing speed of 25 WPM without errors.
Excellent communication skills in English.
Demonstrated commitment to Service Excellence.

Nice To Haves

Two years of college in a related field or business school.
Medical Assistant, LVN, or RN background.

Responsibilities

Receive, process, and document referrals and prior authorization requests.
Obtain and verify insurance pre-authorizations and re-authorizations.
Maintain compliance with documentation standards and insurance requirements.
Collaborate with pediatric clinical teams and Patient Financial Services to support the referral workflow.
Communicate with patients, families, providers, and insurance companies.
Track and adapt to changes in insurance and referral policies.
Support improvements to referral processes and customer service.