Referrals Specialist

Nira Medical•Lutz, FL

3d•Onsite

About The Position

Join one of the Tampa Bay area’s leading outpatient MS and Neuromuscular programs. For more than a decade, our physician-led MS & Neuromuscular Center of Excellence has helped shape neurological care across the region, combining advanced subspecialty expertise, clinical research, and compassionate, patient-centered care. Recognized by the National MS Society as a Partner in MS Care, our team is committed to expanding access to the latest therapies while helping patients navigate complex neurological disease with confidence and hope. You’ll join a physician-led practice with a 4.8-star Google rating, where patients consistently recognize physicians and staff for their expertise, compassion, and commitment to personalized neurological care.

Requirements

High school diploma or equivalent required
Prior experience in a medical office setting, preferably in referral coordination, prior authorization, insurance verification, or patient access.
Working knowledge of HMO and PPO plan structures, referral requirements, and authorization processes.
Knowledge of new patient and follow-up CPT codes, including how they relate to referral and authorization requirements.
Strong attention to detail and organizational skills, with the ability to track multiple open referrals and authorizations and follow them through to completion.
Excellent written and verbal communication skills, with a professional and courteous phone manner.
Ability to work independently, manage competing priorities, and meet deadlines in a fast-paced environment.
Proficiency with spreadsheets and common office software.

Nice To Haves

additional education or certification preferred
Experience with an EMR system and payer portals such as Availity preferred.
Neurology or specialty care experience, particularly with MS, neuromuscular, or infusion therapy patients, is a plus.

Responsibilities

Request and obtain PCP referrals for patients prior to scheduled appointments for both the Clearwater and Lutz neurology offices.
Submit, track, and follow up on HMO authorization requests for new and established patients until a determination is received.
Monitor upcoming appointments to identify referral and authorization requirements in advance and prevent scheduling or billing delays.
Communicate with PCP offices, insurance companies, and patients to resolve missing, expired, or denied referrals and authorizations.
Enter and track all referral and authorization activity in the clinic’s referral tracking spreadsheet and the EMR, including approval dates, visit limits, and expiration dates.
Notify the front desk, scheduling team, and clinical staff when authorizations are pending, approved, or require action.
Escalate authorization denials and complex payer issues to the appropriate leadership or central support team members.
Verify patient insurance eligibility and benefits prior to scheduled appointments.
Confirm that patient insurance is accepted and identify referral or authorization requirements by plan.
Use payer portals such as Availity and individual insurance websites to confirm eligibility and authorization requirements.
Contact patients and/or insurance companies as needed to resolve coverage questions, and communicate coverage information clearly to patients.
Assist with scheduling new patient appointments for faxed referrals received through the EMR and for self-referred patients, as needed.
Contact patients to collect required demographic, insurance, and referral information and enter data accurately into the medical record.
Select appropriate appointment types, dates, and times based on clinic guidelines.
Serve as backup receptionist at the Lutz office when the receptionist is unavailable, including: Checking patients in and out, including verifying and scanning identification and insurance cards and ensuring completion of required forms.
Collecting time-of-service payments, including copays and self-pay balances, in accordance with clinic policy.
Checking patients out per provider instructions documented in EMR tickler notifications, including printing patient education materials, printing laboratory, imaging, and referral orders, scheduling follow-up appointments, and completing infusion drug start forms via DocuSign on clinic iPads.
Answering incoming phone calls related to administrative and scheduling questions in a courteous and professional manner.
Managing patient voicemails, the front desk inbox, and the personal EMR inbox, and responding to patient portal messages in a timely manner.
Perform additional duties as assigned to support patient access, clinic efficiency, and patient satisfaction.