Referral Specialist

Referral Specialist

The Referral Specialist is responsible for processing outgoing patient referrals, including entering referral orders (with physician approval), verifying in-network referral destinations, faxing referrals with pertinent medical documentation, and documenting referral activity in the patient's electronic medical record. The Referral Specialist is also responsible for obtaining authorizations for specialist office visits, as requested, via applicable payer portals.

Supervision Received: Reports to Site Supervisor. Supervision Exercised: None.

Typical Physical Demands: Requires prolonged sitting, some bending, stooping, stretching, and walking short distances to retrieve print jobs, fax confirmations, or to fax records as needed manually. Requires eye-hand coordination and manual dexterity sufficient to operate a computer, keyboard, telephone, and multifunction office equipment (scanner, copier, and fax). Requires a normal range of hearing and eyesight to record, prepare, and communicate appropriate information.

Typical Working Conditions: Standard medical office working conditions.

Examples of Duties:

• Provide excellent customer service (friendly, courteous, and helpful) to both our internal and external customers
• Receive referral requests from specialist offices and communicate diagnosis and referral details to the nurse/medical assistant for physician review and referral ordering.
• Ensure referrals are ordered accurately in the EMR system before processing; review diagnosis and specialty to ensure they are a suitable match. The physician or nurse must order Family Practice referrals, while Pediatric Referral Specialists may enter referral orders with physician approval.
• Verify appropriate specialist destination and ensure referrals are directed to in-network providers when applicable.
• Fax referrals and all pertinent supporting medical records, including clinical notes, lab results, and diagnostic imaging, to the appropriate specialist office within 72 business hours.
• Obtain authorization for specialist office visits upon request by utilizing applicable insurance provider portals (i.e., Availity, UHC, Leading Reach, etc.).
• Notify patients of the specialist/provider they have been referred to for STAT referrals, and provide the specialist's office phone number so the patient may schedule their appointment.
• Answer incoming calls and review voicemail messages throughout the day to respond to patients and specialist offices regarding referral status, authorization requests, and related documentation needs.
• Maintain accurate and timely referral documentation, including recording appointment dates in the Outgoing Referral section of the patient hub, and ensuring all referral and authorization activity is completed efficiently.
• Communicate with nurses/medical assistants via internal messaging to request additional referral details and provide information for review with the physician for approval.

Performance Requirements: Knowledge, Skills, and Abilities: Knowledge of business office procedures. Knowledge of grammar, spelling, and punctuation to type patient information. Skill in operating a computer and a photocopy machine. Skill in answering the telephone in a pleasant and helpful manner. Ability to speak clearly and concisely. Ability to read, understand, and follow oral and written instructions. Ability to sort and file materials correctly by alphabetical or numeric systems. Ability to establish and maintain effective working relationships with patients, employees, and the public.

Education: High school graduation or GED. Experience: One year of work experience, preferably in a medical office setting. Knowledge of medical terminology is desirable. Word processing and computer experience. Certificate/License: None. Alternative To Minimum Qualifications: Additional appropriate education may be substituted for one year of work experience.