Nira Medical→
Referrals Specialist at Nira Medical in Tampa, FL
Job Description
Referrals Specialist
About Our Practice
Join one of the Tampa Bay area’s leading outpatient MS and Neuromuscular programs. For more than a decade, our physician-led MS & Neuromuscular Center of Excellence has helped shape neurological care across the region, combining advanced subspecialty expertise, clinical research, and compassionate, patient-centered care. Recognized by the National MS Society as a Partner in MS Care, our team is committed to expanding access to the latest therapies while helping patients navigate complex neurological disease with confidence and hope.
You’ll join a physician-led practice with a 4.8-star Google rating, where patients consistently recognize physicians and staff for their expertise, compassion, and commitment to personalized neurological care.
Position Summary
The Referrals Specialist plays a key role in patient access for our Clearwater and Lutz neurology offices. This position is responsible for obtaining PCP referrals and HMO authorizations so that patients can be scheduled and seen without delays or coverage surprises. Based at the Lutz office, the Referrals Specialist also serves as backup receptionist when the front desk is unavailable and may assist with new patient scheduling. The role works closely with front desk staff, clinical teams, providers, and central support teams to keep referral and authorization processes accurate, timely, and well documented.
Key Responsibilities
Referral & Authorization Management
Request and obtain PCP referrals for patients prior to scheduled appointments for both the Clearwater and Lutz neurology offices.
Submit, track, and follow up on HMO authorization requests for new and established patients until a determination is received.
Monitor upcoming appointments to identify referral and authorization requirements in advance and prevent scheduling or billing delays.
Communicate with PCP offices, insurance companies, and patients to resolve missing, expired, or denied referrals and authorizations.
Enter and track all referral and authorization activity in the clinic’s referral tracking spreadsheet and the EMR, including approval dates, visit limits, and expiration dates.
Notify the front desk, scheduling team, and clinical staff when authorizations are pending, approved, or require action.
Escalate authorization denials and complex payer issues to the appropriate leadership or central support team members.
Insurance Verification
Verify patient insurance eligibility and benefits prior to scheduled appointments.
Confirm that patient insurance is accepted and identify referral or authorization requirements by plan.
Use payer portals such as Availity and individual insurance websites to confirm eligibility and authorization requirements.
Contact patients and/or insurance companies as needed to resolve coverage questions, and communicate coverage information clearly to patients.
New Patient Scheduling Support
Assist with scheduling new patient appointments for faxed referrals received through the EMR and for self-referred patients, as needed.
Contact patients to collect required demographic, insurance, and referral information and enter data accurately into the medical record.
Select appropriate appointment types, dates, and times based on clinic guidelines.
Backup Front Desk Coverage
Serve as backup receptionist at the Lutz office when the receptionist is unavailable, including:
Checking patients in and out, including verifying and scanning identification and insurance cards and ensuring completion of required forms.
Collecting time-of-service payments, including copays and self-pay balances, in accordance with clinic policy.
Checking patients out per provider instructions documented in EMR tickler notifications, including printing patient education materials, printing laboratory, imaging, and referral orders, scheduling follow-up appointments, and completing infusion drug start forms via DocuSign on clinic iPads.
Answering incoming phone calls related to administrative and scheduling questions in a courteous and professional manner.
Managing patient voicemails, the front desk inbox, and the personal EMR inbox, and responding to patient portal messages in a timely manner.
Other Duties
Perform additional duties as assigned to support patient access, clinic efficiency, and patient satisfaction.
Qualifications
High school diploma or equivalent required; additional education or certification preferred.
Prior experience in a medical office setting, preferably in referral coordination, prior authorization, insurance verification, or patient access.
Working knowledge of HMO and PPO plan structures, referral requirements, and authorization processes.
Knowledge of new patient and follow-up CPT codes, including how they relate to referral and authorization requirements.
Experience with an EMR system and payer portals such as Availity preferred.
Strong attention to detail and organizational skills, with the ability to track multiple open referrals and authorizations and follow them through to completion.
Excellent written and verbal communication skills, with a professional and courteous phone manner.
Ability to work independently, manage competing priorities, and meet deadlines in a fast-paced environment.
Proficiency with spreadsheets and common office software.
Neurology or specialty care experience, particularly with MS, neuromuscular, or infusion therapy patients, is a plus.
Work Location & Schedule
Based at the Lutz office, with support provided to both the Clearwater and Lutz neurology offices.
Full-time, Monday through Friday during clinic hours.