Referral Specialist

Metro Community Health Center; Pittsburgh (Allegheny County); On-site; USD 42,000 - 62,000; Full time

Job summary

Metro Community Health Center in Pittsburgh is seeking a Referral Coordinator to support care coordination. You will track prior authorizations, coordinate referrals for diagnostics and specialty care, and communicate with payers, providers, and patients to prevent delays.

A 1–2 year background in prior authorization or referral coordination, familiarity with EMR/EHR systems, and knowledge of Medicare/Medicaid workflows are preferred.

Qualifications

• 1–2 years of experience in prior authorization or referral coordination.
• Experience with electronic medical records/EHR.
• Familiarity with Medicare/Medicaid and payer requirements.
• Strong organization and communication skills.

Responsibilities

• Track and follow up on prior authorization requests and communications with payers, providers, pharmacies, and patients.
• Coordinate referrals for diagnostic testing, specialist visits, lab orders and results, and related services.
• Contact outside facilities and providers to obtain clinical results and documentation.
• Provide or obtain clinical information to support referrals and authorizations.
• Follow up with patients to support compliance and scheduling needs.
• Close the referral loop by tracking referrals, obtaining results, and updating the EMR.
• Communicate professionally with patients, providers, insurers, and pharmacies to resolve delays.
• Maintain confidential documentation of referral activity per privacy standards.
• Collaborate with clinical/admin team to stabilize workflow between authorizations and follow-up.
• Perform other duties to support patient care and clinic operations.

Skills

Medical terminology

CPT/ICD-10 codes

Referral processes

Insurance documentation

Education

High school diploma

Tools

EMR/EHR systems

Job description

Job Details

Job Location: Legal Address - Pittsburgh, PA, Position Type: Full Time, Salary Range: Undisclosed

Track 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.

Qualifications: POSITION REQUIREMENTS

Education/Experience

• High 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/Abilities

• Working 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/Abilities

• Certified 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.