Referral Specialist

The Vascular Care Group; Hyannis (MA); On-site; USD 34,000 - 41,000; Full time

Job summary

The Vascular Care Group is seeking a detail-oriented Referral Specialist to secure referrals and insurance authorizations for upcoming appointments. You will act as the primary liaison between patients, referring providers, and insurers, ensuring all documentation is complete for each visit.

You will review schedules, obtain referrals, submit prior authorizations, verify coverage, and track statuses while maintaining HIPAA compliance and professional communication in a fast-paced clinical

Qualifications

• High School diploma minimum; degree preferred.
• 1+ year experience obtaining referrals and prior authorizations.
• Vascular, cardiology, or surgical setting experience preferred.
• Familiar with Medicare/Medicaid and payer requirements.
• Proficient with EMR and payer portals; CPT/ICD-10 knowledge.
• Strong communication, detail-oriented, and HIPAA compliant.

Responsibilities

• Review schedules to identify needed referrals/authorizations.
• Obtain referrals from PCPs for visits, ultrasounds, and procedures.
• Submit and follow up on prior authorization requests.
• Verify insurance eligibility and payer requirements.
• Communicate with referring offices for missing referrals.
• Inform patients of status and reschedule as needed.
• Document referral activity with reference numbers and dates.
• Track pending referrals and escalate delays.
• Coordinate with clinical staff and billing.
• Respond to denials and submit retro-authorization when appropriate.
• Maintain knowledge of referral requirements.
• Protect patient confidentiality and HIPAA compliance.
• Complete ad hoc projects.
• Local travel as needed.

Skills

Communication skills

Attention to detail

Multitasking

Professional demeanor

Microsoft Office proficiency

Education

High School Diploma

Associate or Bachelor's degree preferred

Tools

Electronic Medical Records (EMR)

Payer portals

Microsoft Office

Job description

• This candidate should be local to the Cape Area and willing to travel on a monthly basis*

Overview

The Referral Specialist is responsible for securing all required referrals and insurance authorizations for patients with upcoming appointments at The Vascular Care Group. This role serves as the primary liaison between patients, referring providers, and insurance carriers to ensure that every patient arrives for their visit with the appropriate documentation in place. The Referral Specialist supports continuity of care, minimizes appointment delays and denials, and contributes to a smooth, patient-centered experience by proactively managing the referral pipeline. The role is non-exempt.

Responsibilities

• Review upcoming appointment schedules daily to identify patients who require referrals or insurance authorizations prior to their visit
• Obtain referrals from primary care physicians and referring providers for all scheduled office visits, diagnostic studies, and procedures
• Submit and follow up on insurance prior authorization requests for office visits, ultrasound and vascular lab studies, interventional procedures, and surgeries
• Verify patient insurance eligibility and benefits to determine referral and authorization requirements specific to each payer
• Communicate directly with referring physician offices to request missing referrals and provide any clinical documentation needed to support the request
• Contact patients to inform them of referral status, request assistance in obtaining referrals from their PCP when needed, and reschedule appointments if a referral cannot be secured in time
• Document all referral and authorization activity, including reference numbers, approval dates, valid date ranges, and approved visit counts, in the patient's electronic medical record
• Track pending referrals and authorizations and elevate issues that may delay patient care to the Office Manager or clinical team
• Coordinate with clinical staff, schedulers, and billing to ensure referral information is accurate and aligned with the services being rendered
• Respond to insurance denials related to missing or invalid referrals and submit retro-authorization requests when appropriate
• Maintain up-to-date knowledge of referral and authorization requirements for Medicare, Medicaid, and commercial payers
• Protect patient rights by maintaining medical, personal, and financial confidentiality
• Ensure compliance with all HIPAA regulations
• Complete ad hoc projects as requested

Requirements

• Minimum of High School diploma, associate or bachelor's degree preferred
• 1+ years of experience obtaining insurance referrals and prior authorizations in a medical setting required; vascular, cardiology, or surgical specialty experience preferred
• Working knowledge of Medicare, Medicaid, and commercial insurance referral and authorization requirements
• Familiarity with electronic medical records and payer portals
• Knowledge of medical terminology and CPT/ICD-10 coding sufficient to support authorization requests
• Knowledge of multi-line phone systems
• Must be able to maintain a professional demeanor in a fast-paced environment
• Excellent communication skills, both verbal and written, with strong attention to detail and follow-through
• Previous experience with Microsoft Office suite
• Ability to perform multiple tasks in a busy medical setting
• Knowledge of and compliance with HIPAA regulations
• Willing to be available for local and/or regional assignments as needed

Compensation

• $25/hour - $30/hour. Negotiable based on skills and experience.

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