Referral & Authorization Specialist

Paycom - ATS; Pittsburgh (Allegheny County); On-site; USD 42,000 - 52,000; Full time

Job summary

Paycom - ATS in Pittsburgh, PA seeks a Referral Specialist to manage and track prior authorization requests, coordinate referrals for diagnostics, labs, and therapy, and maintain thorough documentation in the EMR while protecting patient privacy.

The role requires 1–2 years in prior authorization or referral coordination, familiarity with Medicare/Medicaid and payer requirements, and strong organizational and communication skills.

Qualifications

• Knowledge of medical terminology, CPT/ICD-10 coding, and referral processes.
• Experience with health insurance documentation and payer requirements.
• Familiarity with EMR/EHR systems and privacy standards.

Responsibilities

• Track and follow up on prior authorization requests with payers, providers, pharmacies, and patients.
• Coordinate and monitor referrals for diagnostics, specialist visits, labs, and ancillary services.
• Contact outside facilities and specialty providers to obtain clinical results and documentation needed for referrals.
• Provide or obtain additional information to support authorization requests.
• Follow up with patients to support compliance with provider orders and assist scheduling diagnostics, labs, or appointments.
• Close referral loop by tracking pending referrals and updating the care team.
• Communicate professionally with patients, providers, insurance representatives, pharmacies, and external organizations to resolve delays.
• Maintain confidential documentation of referral activity in the EMR.
• Collaborate with clinical and administrative teams to stabilize workflow between authorizations and referrals.

Skills

Medical terminology

CPT and ICD-10 codes

Referral processes

Insurance documentation

Organizational skills

Verbal and written communication

Education

High school diploma or equivalent

Tools

Electronic Medical Records (EMR) systems

Job description

Paycom - ATS in Pittsburgh, PA seeks a Referral Specialist to manage and track prior authorization requests, coordinate referrals for diagnostics, labs, and therapy, and maintain thorough documentation in the EMR while protecting patient privacy.

The role requires 1–2 years in prior authorization or referral coordination, familiarity with Medicare/Medicaid and payer requirements, and strong organizational and communication skills.