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HMO Referral Specialist

Precision Healthcare Specialists
Naples, FL Full Time
POSTED ON 2/23/2025
AVAILABLE BEFORE 5/21/2025

Job Description

Job Description

Description :

Precision Healthcare Specialists is a trusted healthcare group committed to delivering quality patient care and seamless medical services. We are seeking a detail-oriented HMO Referral Specialist to manage referrals and insurance verifications for our patients within Health Maintenance Organization (HMO) networks

  • Process and coordinate referrals to in-network specialists and other healthcare providers.
  • Verify patient eligibility and benefits for HMO plans
  • Submit and track referral requests, ensuring timely approvals.
  • Maintain communication with patients, providers, and insurance companies regarding referral status.
  • Accurately document all referral requests and approvals in the Practice Management (PM) system.
  • Educate patients on referral policies and insurance requirements.
  • Ensure compliance with HMO guidelines, HIPAA regulations, and company policies.

Requirements :

  • High school diploma or GED required; associate's degree in healthcare administration or related field preferred.
  • Minimum 2 years of experience in medical referrals, insurance verification, or HMO authorization processing.
  • Strong knowledge of HMO plans, referral procedures, and insurance guidelines.
  • Proficiency in PM, EMR systems and Microsoft Office Suite.
  • Excellent customer service, communication, and problem-solving skills.
  • Ability to multitask in a fast-paced environment and maintain attention to detail.

    • Full Time

    Monday - Friday

    8 : 30AM to 5 : 00PM

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