Referral Specialist

Location:

Pay Range:

The New Patient Referral Specialist plays a crucial role in supporting patient care by managing and coordinating new patient referrals for oncology and hematology services. This position ensures a seamless referral process by verifying insurance requirements and obtaining necessary authorized referrals from referring physicians and insurance carriers. This role is responsible for providing timely communication with patients, providers, and insurance carriers. The New Patient Referral Specialist works closely with the New Patient Intake Department, verification team, and Front Office team to ensure that patients receive the care they need without unnecessary delays.

KPA 1- Referral Coordination & Authorization Management

• Coordinate and process oncology and hematology referrals, including FastTrack and add-on requests, ensuring accuracy, timeliness, and compliance with practice protocols.
• Verify insurance eligibility and network participation and obtain required prior authorizations for office visits, laboratory services, and other applicable treatments.
• Ensure all referrals meet payer, regulatory, and organizational requirements prior to scheduling services.

KPA 2 - Patient Navigation & Customer Service

• Serve as the primary liaison between patients, referring providers, specialists, and external facilities throughout the referral process.
• Educate patients regarding referral details, appointment information, insurance coverage, preparation requirements, and potential financial responsibilities.
• Respond promptly and professionally to patient inquiries and resolve referral-related concerns to promote a positive patient experience.

KPA 3- Documentation & Referral Tracking

• Maintain complete, accurate, and timely referral documentation within the electronic health record (EHR).
• Monitor referral status from initiation through completion, following up as necessary to ensure continuity of patient care.
• Maintain accurate records of insurance changes, referral outcomes, and authorization activity.

KPA 4- Insurance & Regulatory Compliance

• Maintain working knowledge of payer guidelines, authorization requirements, oncology-specific referral processes, and applicable regulatory standards.
• Ensure referral and authorization activities comply with organizational policies, insurance requirements, and documentation standards.

KPA 5- Communication & Cross-Functional Collaboration

• Communicate effectively with patients, physicians, clinical staff, front office personnel, and external providers to facilitate coordinated patient care.
• Collaborate with team members to resolve referral issues, maintain patient care flow, and achieve departmental objectives.
• Provide timely and professional communication through company email and other approved communication channels.

KPA 6- Operational Excellence & Organizational Support

• Prioritize workload effectively while maintaining accuracy and efficiency in a fast-paced healthcare environment.
• Adhere to organizational policies, procedures, and quality standards while embracing process improvements and operational changes.
• Perform additional duties and special projects as assigned by leadership in support of departmental and organizational goals.

Education

• High school diploma or equivalent required.

Minimum Relevant Experience

• Minimum of 2 years of experience in a healthcare setting, preferably in oncology, hematology, or another specialty practice.

• Experience with insurance verification, referral coordination, and prior authorization processes.

• Working experience with health insurance and payer requirements.

• Experience using electronic health record (EHR) systems and standard office technology.

Certifications/Licenses

• None required.

Skills

• Proficiency in insurance verification, prior authorizations, and electronic health record (EHR) systems.

• Strong knowledge of insurance policies, referral processes, and oncology treatment protocols.

• Knowledge of medical office procedures and healthcare administrative workflows.

• Ability to type a minimum of 35 words per minute.

• Proficiency with computers, Microsoft Office applications, and standard office equipment.

• Ability to operate a multi-line telephone system.

• Excellent verbal and written communication skills, including professional telephone etiquette.

• Strong organizational, time management, and multitasking abilities.

• Ability to read, understand, and follow written and verbal instructions in English.

• Ability to establish and maintain effective working relationships with patients, physicians, staff, and external providers.

• Strong customer service and problem-solving skills in a fast-paced healthcare environment.

• Ability to maintain confidentiality and comply with HIPAA and other applicable privacy regulations.

• Ability to prioritize workload, manage multiple responsibilities, and adapt to changing priorities while maintaining accuracy.

Travel: 0-25%

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