Referrals Specialist- Bilingual

TEKsystems•San Ysidro, NM

8d•$25 - $28•Onsite

About The Position

The Referral Coordinator / Authorization Specialist is responsible for managing referral and prior authorization processes to ensure timely access to healthcare services. This role serves as a liaison between patients, providers, specialists, and insurance carriers while maintaining a high level of customer service and accuracy. The ideal candidate will have extensive experience with referral coordination, insurance authorizations, patient scheduling, and EMR systems, along with strong knowledge of commercial, Medicare, and Medi-Cal health plans.

Requirements

High School Diploma or GED required.
Bilingual English/Spanish with full fluency in both spoken and written communication required.
Minimum of 3-5 years of healthcare experience supporting both front-office and back-office operations.
Experience with referral coordination, prior authorizations, insurance verification, patient scheduling, and patient registration.
Strong knowledge of commercial insurance, Medicare, Medi-Cal, eligibility requirements, and payer guidelines.
Experience working with EPIC and/or other Electronic Medical Record (EMR) systems.
Proficiency with Microsoft Office and healthcare scheduling systems.
Typing speed of at least 35 WPM.
Strong customer service, communication, and problem-solving skills.
Ability to manage multiple priorities while meeting deadlines in a fast-paced healthcare environment.

Nice To Haves

Medical Assistant Certificate, Coding Certificate, or Data Processing Certificate.
Previous experience in managed care, specialty referrals, or utilization management.
Experience working in a call center or high-volume patient service environment.

Responsibilities

Receive, review, and process referral and authorization requests accurately and efficiently, ensuring all required documentation is complete.
Coordinate and schedule referrals, specialty appointments, diagnostic testing, Durable Medical Equipment (DME), and other support services as ordered by providers.
Obtain prior authorizations from insurance carriers through phone, fax, email, online portals, and written correspondence.
Monitor and follow up on pending authorizations and missing documentation to ensure timely approval and patient care continuity.
Verify insurance eligibility, benefits, and coverage requirements while adhering to payer-specific guidelines and regulations.
Utilize EPIC and other EMR systems to access patient information, manage referrals, track authorization status, and schedule services.
Provide patients with timely updates regarding referral and authorization status and address questions or concerns professionally.
Collaborate with providers, specialists, insurance representatives, and internal departments to coordinate patient care effectively.
Review referral work queues and logs to ensure referrals are completed and closed appropriately.
Document appointment details, authorization information, and referral outcomes accurately within electronic medical records.
Confirm patient attendance at scheduled appointments and obtain consultation notes, reports, and test results from specialists or facilities as needed.
Maintain confidentiality of patient information and comply with all organizational policies and healthcare regulations.
Adapt to changing workflows, policies, and organizational processes while maintaining productivity and service excellence.
Support coverage at nearby clinic locations as needed.