Referrals Specialist (Dermatology) - Remote | Philippines

Join Our Team at Skin and Cancer Institute!

Are you passionate about dermatology and skin health? Do you thrive in a dynamic, patient-focused environment? Skin and Cancer Institute is looking for dedicated professionals to join our team!

Why Join Us?

At Skin and Cancer Institute, we are committed to excellence in dermatology, skin cancer treatment, and cosmetic procedures. We offer a supportive and collaborative work culture where your skills and dedication make a real impact.

Summary of Position

• Reports to: Authorization Manager
• Work schedule: U.S. Pacific Time, Monday to Friday (maximum of 40 hours per week)
• Work Category: Full-time, Remote

The Referrals Specialist is responsible for receiving, validating, processing, tracking, and documenting inbound referrals to ensure timely access to care and compliance with payer requirements. This position serves as a liaison between referring providers, patients, payers, specialists, scheduling teams, and internal departments to facilitate efficient referral management and continuity of care.

The Referrals Specialist owns the receipt, validation, processing, tracking, and closure of referrals. Eligibility verification and prior authorization activities are coordinated with the teams responsible for those functions to avoid duplicate work. Success requires strong organization, attention to detail, healthcare administrative experience, and the ability to manage multiple priorities in a fast-paced environment.

WHAT YOU'LL DO:

Referral Coordination

• Receive, review, and process inbound referral requests accurately and efficiently.
• Coordinate referrals for general dermatology, Mohs surgery, radiation oncology and other specialty services.
• Ensure referrals contain required clinical notes, insurance information, provider orders, and supporting documentation.
• Validate the patient, servicing provider, specialty, location, service, diagnosis, effective period, and approved visits against payer requirements, when applicable.
• Identify incomplete, invalid, expired, exhausted, or mismatched referrals and obtain or request correction of missing information.
• Maintain referral work queues and prioritize requests based on urgency, appointment date, and departmental standards.

Patient Scheduling Support

• Collaborate with scheduling teams to facilitate timely patient appointments.
• Contact patients regarding referral status, scheduling requirements, and requested documentation.
• Assist patients with understanding referral processes and next steps.
• Notify and coordinate with scheduling or clinical teams when referral requirements are incomplete or unmet.
• Coordinate with clinical staff and providers to address questions related to referrals and medical documentation.

Insurance and Authorization Coordination

• Confirm coverage information relevant to referral requirements through the established eligibility workflow.
• Identify referral-related payer requirements and route prior authorization or precertification needs to the appropriate team.
• Collaborate with eligibility and prior authorization teams to facilitate complete patient clearance.
• Communicate scheduling readiness after applicable referral requirements have been satisfied.
• Monitor referral effective dates, expiration dates, approved visits, and remaining visit balances.

Documentation and Record Management

• Accurately document referral activities within EMR and practice management systems.
• Maintain complete referral records, communications, and supporting documentation.
• Update referral statuses, appointment outcomes, final disposition, and follow-up actions in designated systems.
• Ensure accuracy of patient demographics, provider information, and referral details.
• Monitor referral tracking reports and follow-up queues to ensure timely completion.

Quality and Compliance

• Adhere to HIPAA regulations and patient confidentiality standards.
• Maintain compliance with payer requirements, healthcare regulations, and organizational policies.
• Support quality assurance initiatives through accurate documentation and referral processing.
• Monitor referral turnaround times and identify opportunities for workflow improvement.
• Stay current on payer guidelines, referral requirements, and healthcare industry changes.

Operational Support

• Assist with special projects, operational initiatives, and departmental process improvements.
• Cross-train and provide support to scheduling, eligibility, authorization, and revenue cycle teams as assigned.
• Participate in team meetings, training sessions, and organizational development activities.
• Perform other duties as assigned.

WHAT WE'RE LOOKING FOR

Required Skills / Abilities:

• Strong knowledge of healthcare referral processes and patient access workflows.
• Understanding insurance plans, provider networks, and referral requirements.
• Excellent verbal and written communication skills.
• Strong customer service and patient-relations abilities.
• Outstanding organizational, multitasking, and time management skills.
• Ability to maintain accuracy while managing high-volume workloads.
• Strong problem-solving and critical thinking skills.
• Ability to work independently and collaboratively in a team environment.
• Working knowledge of medical terminology.
• Proficiency in Microsoft 365 applications including Outlook, Word, Excel, and Teams.
• Experience utilizing EMR and practice management systems.
• Ability to maintain confidentiality and professionalism in all interactions.

Education & Experience

Required

• High School Diploma or equivalent.
• Minimum of 2 years of experience in healthcare referrals, patient access, scheduling, insurance verification, medical office administration, or related healthcare operations.
• Experience working with healthcare providers, insurance carriers, and patient scheduling workflows.
• Proficiency with electronic health record systems and Microsoft 365 applications.

Preferred

• Associate's degree in healthcare administration, Business Administration, or related field.
• 3+ years of referral coordination experience within a multi-specialty medical practice.
• Experience in dermatology, oncology, surgical specialties, radiation oncology, or specialty healthcare environments.
• Experience with Modernizing Medicine (EMA), ModMed, NextGen, or similar EMR systems.
• Certified Revenue Cycle Representative (CRCR) or similar healthcare certification.
• Experience supporting remote healthcare operations.

Equipment & Software Operation

The incumbent in this position may operate any/all of the following equipment:

• Microsoft Outlook, Word, Excel, PowerPoint, fax, email, phone, Microsoft Teams, Zoom Call Center, EMA, Klara and Next Patient

WHAT WE OFFER

Placement within the range will be based on objective, job-related factors, which may include relevant experience, education, training, skills, certifications, internal equity, and business considerations

• Competitive salary
• Night shift differential pay
• Statutory benefits
• Paid time off
• Professional development opportunities
• Supportive and fair work environment

Apply Today! Be a part of a dynamic team that’s transforming skin health. We can't wait to meet you!

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