Referral Specialist

Sweetgrass & SouthernMED Pediatrics•Lexington, KY

10d

About The Position

As a Referral Specialist, you support a positive patient experience by efficiently processing requests for referrals, prior authorizations, and diagnostic imaging. The organization’s mission is to provide high-quality, compassionate health care to families in the community and make each encounter pleasant and informative while respecting patients’ and families’ time and individual needs. The position works in an indoor, temperature-controlled, smoke-free, and handicapped-accessible environment. Work may at times involve stressful situations. Pay is determined by years of experience and office location(s).

Requirements

High school diploma or equivalent required.
Minimum 1–2 years of credentialing experience.
Knowledge of credentialing processes, insurance payers, and regulatory standards, such as CAQH, Medicare, and Medicaid.
Strong organizational skills and high attention to detail.
Excellent written and verbal communication skills.
Proficiency with credentialing software, Microsoft Office (Word, Excel, Outlook), and practice management systems.
Ability to work independently and manage multiple deadlines simultaneously.

Nice To Haves

Associate or bachelor's degree preferred.
Credentialing experience in a pediatric or outpatient healthcare setting preferred.

Responsibilities

Facilitate outgoing referral requests, including obtaining prior authorization when necessary.
Obtain prior authorization for patient medications.
Schedule diagnostic imaging requests and obtain prior authorization for them.
Meet position requirements and perform essential functions.
Complete all mandatory training as required.
Perform other duties as assigned.