Referral Specialist

Job Description

Job Description

Referral Specialist

Job Description

Referral Specialist

Location-Dade City

General Description

The Referral Specialist manages a high volume of referrals and pre-authorizations for multiple providers. This role collaborates closely with other referral specialists, patient service representatives, clinical staff, health plans, providers, and patients to ensure referrals are processed accurately and efficiently. The Referral Specialist serves as a key liaison to support timely access to specialty and additional care services.

Essential Duties & Responsibilities

• Assist with patient referrals for additional services with internal and external medical facilities
• Ensure referrals are processed accurately, efficiently, and in a timely manner
• Communicate with providers and patients regarding referral status and any barriers
• Contact insurance carriers to generate referrals and submit required clinical documentation
• Enter referral data into the practice management system
• Provide required documentation to specialty provider offices prior to appointments
• Educate patients on referral requirements and responsibilities
• Request and process insurance authorizations and forward approvals to specialty providers
• Scan and upload referral documentation into patient charts
• Close expired referrals and follow up on pending referrals, including sending letters to non-compliant patients
• Maintain confidentiality and comply with HIPAA requirements at all times
• Communicate workflow disruptions that impact patient flow to care team members
• Support community give-back initiatives and advocate for Premier’s mission
• Adhere to Premier’s core values and patient care standards to ensure an excellent patient experience
• Participate in departmental goals and Quality Improvement / Quality Assurance (QI/QA) activities
• Perform other duties as assigned

Knowledge, Skills & Abilities

• Basic understanding of medical terminology and clinical documentation
• Ability to perform repetitive tasks with accuracy and attention to detail
• Basic mathematical skills
• Strong customer service skills with empathy and compassion
• Ability to communicate clearly and professionally, verbally and in writing
• Excellent grammar, spelling, and interpersonal skills
• Professional demeanor, strong work ethic, and positive attitude
• High ethical standards with strict adherence to confidentiality and Premier values

Qualifications

• High School Diploma or GED required
• Two (2) years of experience in insurance verification or a healthcare environment preferred
• Ability to obtain and maintain Epic certification and annual compliance training

Working Conditions & Physical Requirements

• Ability to lift 20 lbs. regularly and 30–50 lbs. occasionally
• Ability to sit for extended periods
• Direct exposure to computer screens
• Possible exposure to contagious or infectious diseases

(See Job Description attached for more information)