Pediatric Referral & Authorization Specialist

US Pediatric Partners; Lexington (SC); On-site; USD 34,000 - 46,000; Full time

Benefits offered by this job

Paid Time Off

Matching 401K

Annual Merit Increases

Mental Health and Counseling Programs

Dental and Orthodontic Coverage

Vision Insurance

Health Care with Low Premiums

Short-term Disability

Access to Virtual Health & Wellness

Job summary

US Pediatric Partners seeks a Referral Specialist to support a positive patient experience by efficiently processing referrals, prior authorizations, and diagnostic imaging requests.

You will collaborate with families and providers, schedule and track authorizations, maintain accurate records, and comply with payer requirements while delivering compassionate, pediatric-focused service in a busy outpatient setting.

Qualifications

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

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.
• Meets position requirements and performs essential functions.
• Completes all mandatory training as required.
• Performs other duties as assigned.

Skills

Credentialing experience

Organizational skills

Communication skills

Credentialing software

Microsoft Office

Independent worker

Multitasking

Education

High school diploma

Associate degree

Bachelor's degree

Tools

Credentialing software

Practice management systems

Job description

US Pediatric Partners seeks a Referral Specialist to support a positive patient experience by efficiently processing referrals, prior authorizations, and diagnostic imaging requests.

You will collaborate with families and providers, schedule and track authorizations, maintain accurate records, and comply with payer requirements while delivering compassionate, pediatric-focused service in a busy outpatient setting.