Medical Referral Specialists
Full Time ₱19,000 - ₱21,600 / monthJob Overview
Virtual Staffing Solutions is currently looking for Medical Referrals Specialists to join our growing healthcare support team. In this role, you will play a key part in managing patient referrals by verifying insurance coverage, securing authorizations, and ensuring that all referral-related documentation is accurate and complete. You will help ensure patients receive timely access to the care they need while supporting efficient billing and claims processing.
Key Responsibilities
- Obtain and process referrals from providers and communicate authorizations with patients (via phone and mail) and medical staff in a timely manner.
- Prepare, process, and complete referrals accurately and promptly, including urgent and stat referrals for assigned members.
- Track referrals in the electronic medical records (EMR) system and follow up on submitted authorization requests while maintaining consistent status updates in the EMR.
- Monitor and report on the status of authorization requests and escalate issues as necessary until fully resolved and the referral loop is closed.
- Communicate referral, authorization, and pertinent medical information to patients and specialty providers.
- Manage redirections across all clients and payers by collaborating with clinical teams to ensure timely re-authorizations before expiration to prevent lapses in authorization or delays in patient care.
- Review consultation reports for required follow-up requests and coordinate with providers to ensure timely processing of all follow-ups.
- Work with the Health Information (Medical Records) Department to ensure timely retrieval of consultation reports.
- Assist patients with scheduling specialist appointments if they experience challenges in doing so independently.
- Submit retro-authorizations and distinguish between primary care and internal specialty visits.
Skills, Knowledge and Expertise
- Minimum of 6 months experience in the US healthcare industry required.
- Strong understanding of US medical billing, collections, coding, and healthcare regulations is a plus.
- Experience with ICD-10 and CPT code assignment is an advantage.
- Excellent written and verbal communication skills.
- Computer literate, in encoding, and word-processing