Referral Management Specialist

The compensation range listed reflects the range Northern Light Health anticipates relying on in setting the wages for the position. The range may not necessarily include all additional compensation elements available, such as differentials, incentive programs and benefits.

Northern Light Health

Department: Physician Practice Central Ops

Position is located: Cianchette Professional Blding

Work Type: Full Time

Hours Per Week: 40.00

Work Schedule: 8:00 AM to 4:30 PM

Exempt: No

Summary :

The Referral Management Specialist is a key member of a centralized, coordinated team responsible for supporting all referral-related activities and facilitating seamless care coordination across the Northern Light Health system. The Specialist manages the end-to-end referral process, including prior authorizations, ambulatory orders, and the scheduling of appointments and procedures, with a focus on minimizing delays, preventing denials, and optimizing access to care.

This role requires applied knowledge of medical terminology, CPT and ICD-10 coding concepts, payer-specific authorization requirements, and electronic medical record (EMR) and operating room (OR) scheduling systems. Acting as a critical liaison across the care continuum-including primary care, specialty practices, operating rooms, ancillary departments, leadership teams, and insurance carriers-the Specialist supports clinical efficiency, protects organizational revenue, and enhances patient experience.

Operating in a fast-paced, high-volume environment, the Referral Management Specialist independently prioritizes multiple competing demands across providers and locations while maintaining accuracy, compliance, and responsiveness. The role involves frequent oral and written communication with patients, providers, and internal stakeholders at all levels of the organization.

Throughout all responsibilities, the Specialist consistently models Northern Light Health's core values of Integrity, Respect, Accountability, and Compassion, contributing to high-quality, coordinated, and patient-focused care delivery.


Responsibilities :

• Monitor EMR referral queues and Multi Patient Task Lists (MPTLs) in real time; capture, review, and process outgoing and incoming referrals and orders.
• Prepare, submit, and track prior authorizations for diagnostics, procedures, surgeries, and specialty services per payer rules.
• Schedule surgical cases and appointments as necessary, leveraging both EMR and OR scheduling platforms and evaluating room and resource allocation and utilization.
• Serve as liaison among patients, referring providers, specialty offices, insurers, and ancillary departments to resolve issues and expedite care. Including but not limited to: communicating referral/scheduling status, next steps, and preparation instructions with clarity and compassion.
• Utilize payer portals; maintain current knowledge of Medicare and commercial plan rules, inpatient vs. outpatient status, and benefit limitations.
• Other Duties

Other Information :

• Working knowledge of CPT/ICD-10 coding, HIPAA regulations, payer authorization rules, and inpatient vs. outpatient distinctions.
• Proficiency with EMR/EHR workflows, OR scheduling platforms and payer portals.
• Exceptional communication, customer service, and organizational skills.
• Ability to work independently and meet productivity standards.
• 2+ years in medical office, care access, referrals/prior auths, scheduling, or surgical scheduling; OR an associate degree in healthcare administration, business, HIM, medical coding, or related field.

Competencies and Skills

• Achieves Results: Sets high standards for their own outcomes and seizes opportunities to engage others towards objectives. Consistently moves forward with direct actions in order to attain or exceed objectives. Manages their own time effectively to accomplish assigned tasks. Successfully prioritizes multiple projects and duties as needed.
• Acts Strategically: Creates effective plans that anticipate future consequences and opportunities and is able to connect the day to day operations to longer-term objectives, shifts in the industry, and system goals.
• Adobe Acrobat
• Applies Business Acumen:Demonstrates knowledge of current and future trends that impact organizational success. Applies proven practices and business theories to get results that meet financial as well as other business goals. Recognizes opportunities for new services and products and acts accordingly, taking measured risks into consideration. Possesses a thorough knowledge of their field and independently carries out their work in accordance with professional standards of the profession.
• Electronic medical record software.
• Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one's behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.
• Demonstrates Emotional Intelligence: Exhibits a high level of self-awareness, self-management, other awareness and relationship management. Conducts themselves in an empathic, appropriate way, with a sense of humor and stimulates a collaborative work environment. Is respectful of the attitudes, feelings, or circumstances of others and aware of the influence of their own behavior on them. Is aware of relevant social, political, system, and professional trends and developments and uses this information for the organization's benefit.
• Develops Self and Others:Takes responsibility for engaging in professional self-development activities and programs. Strives to gain insight into their own values, strengths and weaknesses, interests and ambitions and takes action in order to enhance competencies and skills when possible. As a leader, encourages and guides employees towards growth opportunities to enhance performance and help them reach goals. Reviews and analyzes employees' strengths and weaknesses to distinguish their talents and development needs, and to ensure they are enhanced appropriately.
• Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.
• Exercises Sound Judgment & Decision Making: Understands and processes complex information, which allows for appropriate and accountable conclusions. Does not react too quickly or slowly. Balances facts, goals, and potential approaches taking the appropriate criteria into account. Makes active decisions and commits oneself by communicating confidently and respectfully.
• Fosters Innovation: Employs and encourages the use of meaningful creativity in solving challenges. Proactively identifies opportunities and uses new approaches to enhance processes, systems and services. When appropriate, suggests or initiates new strategies, products, services, and markets.
• Experience supporting hardware including computers, laptops, network devices and telephones.
• Influences and Inspires: Builds enthusiasm and commitment among others to move in a desired direction and models it personally. Creates a compelling vision of success that motivates workplace initiative and energizes others to follow. Provides direction and guidance to encourage cooperation between team members in order to attain an objective. Has the ability to appropriately influence others' actions and decisions with and without express authority.
• Types at 60+ words per minute. (only to be used as a condition of employment)
• Ability to understand the language used to precisely describe the human body including its components, processes, conditions affecting it, and procedures performed upon it.
• Spreadsheet application with the ability to use calculations, formulas, graphing tools, pivot tables, and a macro programming.
• Word processing, spreadsheets, data entry, database experience and other computer related skills.
• Email application with the ability to manage email as well as calendars, managing tasks and contacts, note taking, journaling, and web browsing.
• Presentation software with the ability to create presentations with the ability to incorporate animation, audio, video, time delays, as well as designing themes and variants with animations and effects.
• MS Teams
• Word process application with the ability to create and edit documents, format, use tables, apply footnoting, create table of contents and mail merge techniques.
• Multi-line phone, scanner, photocopier, fax, and internet.
• OneNote
• Provides Patient-Centered Care: Demonstrates understanding of patient care quality and service as organizational priority. Proactively supports change to improve patient experience and results. Exhibits the ability and willingness to find out what the patient wants and needs and to act accordingly, taking the organizational and outside resources into account. Cooperates, collaborates, communicates, and integrates care within and between teams to ensure that care is continuous and reliable.
• Resolves Conflict: Promptly acts to find alternatives/solutions when team members disagree. Addresses issues in a direct, honest, and appropriate manner. Handles conflicting interests diplomatically and helps to solve them. Transforms difficult situations into teachable moments using respect and accountability .
• Seeks Process Improvement & Applies System Thinking: Possesses and gains insight into situations, problems and processes. Understands the interconnection between organizational elements. Deconstructs problems and systematically investigates the various components. Considers the impact of actions on the entire process/system. Detects problems and opportunities, recognizes important information, and links various data to trace potential causes and relevant details.
• Serves Others: Strives to understand, meet and exceed the expectations and requirements of internal and external customers which may include the people and communities in our service areas. Develops and maintains relationships, alliances and coalitions within and outside the organization and leverages them in order to obtain information, support, and promote cooperation and collaboration.
• Utilizes Resources Effectively: Understands how to get the most out of available resources and uses cost-benefit thinking in decision-making and in setting priorities. Monitors and analyzes resource usage to identify and eliminate areas of waste and maximize resources. As a leader, defines targets and provides appropriate means; oversees progress and makes adjustments when necessary. Appropriately delegates work, sets clear direction and manages workflow and time.
• Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
• Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of belonging, empowerment, and cooperation.
• Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
• Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.

Education

• Required Associate's DegreeIn lieu of education, two years of experience is required per year of required education, exclusive of the minimum experience identified above.

Required Experience

• 2 year/years of Relevant Work Experience

Working Conditions

• Potential exposure to abusive and/or aggressive people.
• Potential exposure to noise levels being uncomfortable.
• Work with computers, typing, reading or writing.
• Prolonged periods of sitting.
• Lifting, moving and loading less than 20 pounds.

As an integrated health delivery system serving Maine, Northern Light Health is raising the bar with no-nonsense solutions that are leading the way to a healthier future for our state. Our care team-in hospitals, primary and specialty care practices, long-term and home healthcare, behavioral healthcare, and ground and air medical transport and emergency care-are committed to making healthcare work for you: our patients, communities, and employees.

Questions? Contact Talent Acquisition:
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Brewer, Maine, Corporate Office, Cianchette, Foundation, Finance, Human Resources, Legal Services