Job Title: Remote Referral Specialist
Hours: Monday - Friday 
Two shifts: 7:30am - 4pm or 9am - 5:30pm
Location:  Full remote - DC Metro area candidates only
Compensation: $24-28/hr Medical benefits and PTO

Company Overview: A leading managed care organization committed to providing high-quality healthcare services to our members. We pride ourselves on delivering comprehensive care solutions that prioritize patient well-being and satisfaction. As we continue to grow, we are seeking a dedicated Remote Referral Specialist to join our team and contribute to our mission of delivering exceptional healthcare experiences.

Position Overview: As a Remote Referral Specialist, you will play a vital role in facilitating the referral process for our members, ensuring they receive timely access to the care they need. This position requires a strong understanding of authorization procedures within managed care organizations, as well as excellent communication and organizational skills. The successful candidate will work remotely, collaborating with various stakeholders to streamline the referral process and enhance the overall patient experience.

Responsibilities:

1. Review and process referral requests from healthcare providers, ensuring all necessary information is complete and accurate.
2. Verify patient eligibility and insurance coverage to determine authorization requirements.
3. Communicate with healthcare providers, members, and internal teams to gather additional information as needed.
4. Obtain authorizations from insurance companies for specialty services, diagnostic tests, and other medical procedures.
5. Document all referral-related activities in the appropriate systems, maintaining thorough and accurate records.
6. Monitor referral status and follow up on pending authorizations to expedite the approval process.
7. Collaborate with care coordinators and other team members to coordinate care plans and ensure seamless transitions between healthcare providers.
8. Provide support and guidance to members regarding their referral status, coverage, and next steps in the care process.
9. Stay updated on changes to insurance policies, referral guidelines, and industry regulations to ensure compliance and efficiency.
10. Participate in training sessions and professional development opportunities to enhance knowledge and skills related to referral processing and managed care operations.

Qualifications:

1. Associate's degree in healthcare administration, business administration, or certified medical assistant or billing and coding certificate required.
2. Minimum of one year of experience in referral processing within a large managed care organization or healthcare setting.
3. Strong understanding of insurance authorization procedures, including knowledge of medical terminology, CPT/HCPCS codes, and billing processes.
4. Excellent communication skills, with the ability to interact professionally and effectively with healthcare providers, insurance companies, and internal stakeholders.
5. Detail-oriented approach to reviewing and processing referral requests, with a focus on accuracy and completeness.
6. Proficiency in using electronic health records (EHR) systems and other relevant software applications.
7. Ability to work independently in a remote setting, managing time and priorities effectively to meet deadlines and achieve performance targets.
8. Strong organizational and problem-solving skills, with the ability to multitask and adapt to changing priorities in a fast-paced environment.
9. Commitment to maintaining patient confidentiality and adhering to ethical standards in all aspects of work.
10. Remote work experience and familiarity with virtual communication tools (e.g., video conferencing, instant messaging) preferred.

Benefits:

• Competitive salary commensurate with experience
• Comprehensive benefits package, including health insurance, dental and vision coverage, and retirement savings plans
• Flexible remote work environment with opportunities for professional growth and development
• Supportive team culture that values collaboration, innovation, and work-life balance

Join our team and make a difference in the lives of our members by ensuring they have access to the care they need, when they need it. Apply now to become a valued member of our Remote Referral Specialist team