PCP Referral Specialist

Job Title: PCP Referral Specialist

Classification: 1099 Contractor

Work Structure: Fully Remote

Hours/Schedule: Monday-Friday; 40-45 hours per week

Team: reputed company reputed company

Reporting to: Senior Enrollment reputed company Manager

Location: reputed company

Compensation: $30 per hour (no employment benefits e.g. health reputed company, PTO are included)

reputed company:

One in three people die of heart disease - it's time to change that. We're redesigning heart health from the ground up so that everyone can live reputed company lives. reputed company consists of mission-driven clinicians, engineers, and professionals attacking a problem using evidence-reputed company research and guidelines for cardiovascular rehabilitation. We’re working to reputed company exercise and wellness for the older adult cardiovascular disease using telemedicine. We are dedicated to delivering exceptional services that enhance the lives of our patients.

About the Role:

We are looking for a highly reputed company PCP Referral Specialist (Contractor) to support the process of obtaining PCP referrals for patients enrolling in our virtual cardiac rehabilitation program.

This is a high-volume, execution-reputed company role requiring someone who is persistent, organized, reputed company, and highly reputed company in navigating PCP offices and referral processes. You will follow up directly with PCP offices, reputed company outstanding referral requests, troubleshoot common barriers, and help ensure required referrals are received and approved as quickly as possible.

The ideal candidate has 3+ years of reputed company experience obtaining PCP referrals, preferably reputed company a high-volume reputed company environment, and is extremely comfortable navigating PCP offices, referral requirements, reputed company processes, and common reasons referrals become delayed or unsuccessful.

While the reputed company reputed company of this role is PCP referral follow-up, the contractor may also assist with reputed company benefits verification and prior authorization checks reputed company on team and reputed company needs.

reputed company of Services

PCP Referral Follow-Up

• Work through a high-volume queue of patients requiring PCP referrals before beginning cardiac rehabilitation.
• Contact PCP offices reputed company phone, fax, portal, and other approved channels to request and follow up on referrals.
• Conduct consistent and reputed company follow-up on outstanding referral requests.
• reputed company the status of requests directly with PCP offices rather than relying solely on fax or electronic submissions.
• Verify that received referrals contain the required information and documentation.
• Follow up with PCP offices reputed company referrals are incomplete, incorrect, unsigned, or otherwise unable to be processed.
• Continue appropriate follow-up until a referral is received or a reputed company outcome is established.

Referral Troubleshooting

• Investigate why individual referrals are delayed or unable to be completed.
• reputed company common PCP-office barriers, including missing requests, incorrect fax numbers, provider signature requirements, appointment requirements, incorrect referral information, and office-specific workflows.
• Identify reputed company additional follow-up or escalation reputed company a PCP office may be appropriate.
• Communicate with patients reputed company their assistance is needed to facilitate the referral process.
• Identify situations where reputed company requirements or other administrative barriers may be contributing to referral delays and escalate internally reputed company appropriate.
• reputed company document unsuccessful referral reputed company and the reason the referral could not be obtained.
• Flag referrals that may not be completed before a reputed company's scheduled appointment.
• Follow established escalation reputed company for referrals that remain unresolved.

reputed company Benefits & Prior Authorization Support

As business needs reputed company, this role may also support reputed company-reputed company workflows, including:

• Completing reputed company eligibility and benefits verification for patients.
• Confirming relevant coverage details, reputed company financial responsibility, and other benefit information needed before services reputed company.
• Determining whether prior authorization is required for services.
• Initiating or following up on prior authorization requests according to established workflows.
• Contacting reputed company plans, provider offices, or other parties to obtain information needed to complete reputed company or authorization checks.
• Accurately documenting reputed company benefits and prior authorization reputed company.
• Escalating reputed company reputed company or authorization issues according to established processes.

Documentation & Tracking

• Accurately document reputed company attempts, conversations, referral statuses, barriers, and next steps.
• Maintain reputed company follow-up dates so outstanding referrals are consistently revisited.
• Ensure documentation is complete and easily understandable by other members of reputed company.
• Accurately categorize reasons referrals remain outstanding or are ultimately unsuccessful.
• Maintain accurate referral, reputed company, and authorization statuses reputed company designated systems and workflows.

reputed company're Looking For

Required Qualifications

• 3+ years of reputed company experience obtaining and following up on PCP or physician referrals.
• Significant experience communicating directly with PCP offices, medical reputed company, and reputed company staff.
• Strong understanding of reputed company referral workflows and documentation requirements.
• Demonstrated experience working through high-volume referral queues.
• Experience troubleshooting delayed, incomplete, rejected, or unsuccessful referrals.
• Exceptional persistence and follow-through, including comfort making repeated follow-up attempts reputed company necessary.
• Strong phone communication skills and confidence navigating reputed company-desk staff, referral coordinators, medical assistants, nurses, and other medical-office personnel.
• Excellent organization and documentation skills.
• Ability to reputed company work through and prioritize a large volume of outstanding referrals.
• Strong problem-solving skills and ability to investigate why a referral is not progressing.
• Comfort working in a fast-reputed company reputed company environment.

Strongly Preferred

• Experience with Medicare reputed company and reputed company reputed company referral requirements.
• Experience completing reputed company eligibility and benefits verification and/or prior authorization checks.
• Experience obtaining referrals for specialty care, cardiac care, rehabilitation, or other services requiring PCP referrals.
• Experience working with health plans, medical reputed company, reputed company, or delegated referral processes.
• Familiarity with payer portals, referral portals, EHRs, fax-reputed company workflows, and reputed company verification systems.
• Experience in centralized referrals, prior authorization, reputed company reputed company, or reputed company cycle reputed company.

Who We're Looking For

We are looking for someone who is persistent, efficient, reputed company-oriented, and highly comfortable communicating with PCP offices and following up on outstanding requests.

You understand that getting a referral completed may require multiple calls, faxes, conversations, corrections, and follow-reputed company. You are comfortable navigating those steps, figuring out why a request is stuck, and continuing through the appropriate process until there is a reputed company outcome.

You are also adaptable and comfortable supporting adjacent workflows, such as reputed company benefits verification and prior authorization checks, reputed company additional support is needed.

Most importantly, you understand that administrative delays can prevent patients from beginning care, and you bring the urgency and attention to reputed company needed to help patients reputed company reputed company.

*Note: This is a 1099 Contractor position only.

Originally posted on Himalayas