Referral 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

Referral SpecialistPittsburgh, PA 15218; PITTSBURGH, PA 15218DescriptionTrack and follow up on prior authorization requests after submission, including communication with payers, providers, pharmacies, and patients as needed.Coordinate and monitor referrals for diagnostic testing, specialist visits, laboratory orders and results, and ancillary services such as physical therapy, home health care, and durable medical equipment.Contact outside facilities, physician offices, and specialty providers to obtain clinical results, visit summaries, consultation notes, and other required documentation.Provide or obtain additional clinical information needed to support referral and authorization requests.Follow up with patients to support compliance with provider orders and assist with scheduling diagnostics, labs, specialist appointments, or pharmacy-related needs.Help close the referral loop by tracking pending referrals, obtaining results or reports, updating the care team, and ensuring documentation is complete in the electronic medical record.Communicate professionally with patients, providers, insurance representatives, pharmacies, and external healthcare organizations to resolve delays or barriers to care.Maintain accurate, timely, and confidential documentation of referral and authorization activity in accordance with organizational policies and applicable privacy standards.Collaborate with clinical and administrative team members to stabilize workflow between prior authorizations, patient referrals, and provider follow-up.Perform other related duties as assigned to support patient care coordination and clinic operations.#LPQualificationsPOSITION REQUIREMENTS:Education/ExperienceHigh school diploma or equivalent required.Minimum of 1–2 years of experience in prior authorization, referral coordination, insurance verification, medical office support, or related healthcare administrative work.Experience working with electronic medical records or electronic health records.Familiarity with Medicare, Medicaid, managed care plans, payer requirements, and authorization workflows.Skills/AbilitiesWorking knowledge of medical terminology, CPT and ICD-10 codes, referral processes, and insurance documentation requirements.Strong organizational skills, attention to detail, and ability to follow tasks through to completion.Excellent verbal and written communication skills, including professional telephone etiquette.Ability to manage multiple priorities in a fast-paced clinical office environment.Ability to handle sensitive patient information with professionalism and confidentiality.Preferred Skills/AbilitiesCertified Medical Assistant credential preferred.Experience in a primary care, family practice, community health, or federally qualified health center setting preferred.Experience coordinating referrals for diagnostics, specialty care, labs, durable medical equipment, home health care, or physical therapy preferred.PI4a1c2488a2a5-25404-41400973