Job Overview We are seeking a dynamic and detail-oriented Referral Specialist to join our healthcare team. In this vital role, you will serve as the primary point of contact for coordinating patient referrals, ensuring seamless communication between providers, insurance companies, and patients. Your expertise will help facilitate timely access to specialized care while maintaining strict adherence to confidentiality and healthcare regulations. This position offers an exciting opportunity to make a meaningful impact on patient outcomes through efficient referral management and exceptional customer service. Duties Manage and process patient referrals by verifying insurance coverage, obtaining necessary authorizations, and ensuring all documentation complies with healthcare policies. Collaborate with healthcare providers, insurance companies, and patients to facilitate smooth referral workflows. Utilize Electronic Health Record (EHR) systems and other medical office software to document referral details accurately and update patient records promptly. Conduct insurance prior authorization procedures, including reviewing health insurance policies, CPT (Current Procedural Terminology) coding, ICD (International Classification of Diseases) coding (ICD-9, ICD-10), and medical billing requirements. Verify insurance benefits, eligibility, and coverage limits while adhering to HIPAA (Health Insurance Portability and Accountability Act) regulations to protect patient confidentiality. Maintain comprehensive knowledge of managed care policies, health insurance policies, and clinical confidentiality policies to ensure compliance in all activities. Provide excellent customer service by addressing patient inquiries related to referrals, insurance verification, and appointment scheduling efficiently and professionally. Experience Prior experience working in a medical office environment or healthcare setting is highly preferred. Strong knowledge of health insurance policies, managed care processes, and medical billing procedures. Familiarity with medical terminology, CPT coding, ICD coding (ICD-9 & ICD-10), and electronic health records (EHR) management systems. Experience handling insurance verification, prior authorization requests, and medical records management. Excellent communication skills with a focus on customer service excellence in fast-paced environments. Knowledge of HIPAA compliance standards and clinical confidentiality policies is essential. Previous medical office experience is a plus but not required. Join us in delivering exceptional healthcare coordination that improves patient access to vital services! This paid position offers the chance to develop your skills in a supportive environment dedicated to professional growth and outstanding service delivery.

Hours of Operation:

Daily 8:00 am - 5:00pm Please note: this is an on-site position located on Oʻahu, Hawaiʻi. Local applicants are preferred. You may apply through this indeed ad or you may email your resume and cover letter to apply@pmghawaii.org.

Pay:

$18.00 - $20.00 per hour

Benefits:

401(k) 401(k) matching Dental insurance Health insurance Paid time off Vision insurance

Work Location:

In person