Referral Specialist

Essential Functions

• Must be on site twice a week and reside locally.
• Receive, review, and process provider-initiated referrals to specialty and ancillary services.
• Verify insurance eligibility and determine prior authorization requirements.
• Prepare and submit complete referral documentation to payers or external providers.
• Communicate with specialists, imaging centers, and hospitals to schedule and confirm patient appointments.
• Follow up on pending or incomplete referrals to ensure timely completion.
• Document all referral activity in the electronic health record (EHR), ensuring accuracy and completeness.
• Notify patients of referral status, authorization approvals, and appointment details.
• Provide assistance and education to patients regarding the referral process, coverage limitations, or community resources.
• Help identify and resolve barriers to care, such as transportation or communication challenges.
• Collaborate closely with medical providers, care managers, and front desk staff to support continuity of care.
• Maintain effective communication with external specialists and ensure clinical information is exchanged as needed.
• Track and close referral loops, ensuring that results and consult notes are received and routed to the ordering provider.
• Adhere to payer, FQHC, and HIPAA regulations regarding documentation and patient confidentiality.
• Support quality improvement efforts related to referral completion and care coordination.
• Participate in training, team meetings, and workflow improvement initiatives.
• Maintain exemplary customer service.

Education and Experience

• High school diploma or equivalent required; associate degree in healthcare administration or related field preferred.
• Minimum 2 years of experience in a medical office or health system performing referral coordination, scheduling, or prior authorizations.
• Experience in an FQHC, community health center, or primary care setting strongly preferred.
• Knowledge of insurance plans, authorization requirements, and referral workflows.
• Proficiency in Epic strongly preferred.