Referral 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

Description

We value our families we serve, our communities and our team members. As a Referral Specialist you support a positive patient experience by efficiently processing requests for referrals, prior authorizations, and diagnostic imaging.

What it means to be a Referral Specialist with Us

At our offices, we do our best each day to provide high quality, compassionate health care to the families in our communities, treating each child as our own. Our staff and providers strive to make each encounter pleasant and informative while respecting the time and individual needs of our patients and families.

Benefits that Matter!

• 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

What a day looks like as a Referral Specialist

• Facilitates outgoing referral requests which include 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.

Requirements

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.

Working Conditions & Physical Requirements

• Indoor, temperature controlled, smoke free environment.
• May at times work under stressful situations.
• Handicapped accessible.

Pay is detemined by years of experience as well as location(s) of the office. We hope that you find this position as an exciting opportunity and look forward to the potential of speaking with you!