Pediatric Referral & Authorization Specialist

SouthernMED Pediatrics; Lexington (SC); On-site; USD 34,000 - 42,000; Full time

Benefits offered by this job

PTO

401K match

Annual merit increases

Mental health support

Dental coverage

Vision insurance

Health care with low premiums

Short-term disability

Virtual health & wellness

Job summary

SouthernMED Pediatrics is seeking a Referral Specialist to support a positive patient experience by efficiently processing referrals, prior authorizations, and diagnostic imaging requests. The role emphasizes completing all required training and meeting essential functions in a pediatric outpatient setting.

We value high-quality care for families and strive to provide compassionate service while respecting patient and family needs.

Qualifications

• High school diploma or equivalent required; associate or bachelor's degree preferred.
• Minimum 1–2 years of credentialing experience, preferably in pediatric/outpatient healthcare.
• Knowledge of CAQH, Medicare and Medicaid credentialing, insurance payers and regulatory standards.
• Strong organizational skills with high attention to detail.
• Excellent written and verbal communication skills.
• Proficiency with credentialing software, Microsoft Office and practice management systems.
• Ability to work independently and manage multiple deadlines.

Responsibilities

• Facilitates outgoing referral requests including obtaining prior authorization when necessary.
• Obtains prior authorization for patient medications.
• Schedules and obtains prior authorization for diagnostic imaging requests.
• Meeets position requirements and performs essential functions.
• Completes all mandatory training as required.
• Performs other duties as assigned.

Job description

SouthernMED Pediatrics is seeking a Referral Specialist to support a positive patient experience by efficiently processing referrals, prior authorizations, and diagnostic imaging requests. The role emphasizes completing all required training and meeting essential functions in a pediatric outpatient setting.

We value high-quality care for families and strive to provide compassionate service while respecting patient and family needs.