Lead Referral Specialist

Lead Referral Specialist

Neighborhood Outreach Access to Health (NOAH) is a Federally Qualified Health Center (FQHC) that offers comprehensive, integrated, and affordable healthcare services to people in need. We serve over 40,000 neighbors with a variety of services, including medical, dental, behavioral health, nutrition, preventive health, eligibility assistance, and health education programs.

At NOAH, we are dedicated to promoting the overall wellness of our employees by fostering a supportive and balanced work environment. We understand the importance of physical, mental, and emotional well-being, and we strive to create a workplace where our team members can thrive both personally and professionally. Join us in making a difference in our community while enjoying a fulfilling and rewarding career.

Job Summary: The Lead Referral Specialist provides day-to-day support, peer guidance, and workflow assistance to Referral Specialists within the Patient Contact Center. This role serves as a subject matter expert for referral processing, referral documentation, payer requirements, prior authorization workflows, referral status management, and referral closure expectations. The Lead Referral Specialist supports timely and accurate processing of referrals by assisting staff with workflow questions, helping identify barriers, supporting nesting and workflow reinforcement in partnership with the Patient Access Trainer and leadership, and escalating issues to leadership when needed. This position also assists leadership with monitoring referral work queues, supporting staff development, reinforcing department expectations, and promoting compliance with organizational policies, HIPAA, privacy requirements, and applicable healthcare regulations.

Lead Responsibilities:

• Provide day-to-day guidance, workflow support, and peer assistance to assigned agents.
• Serve as a subject matter expert for referral processing workflows, payer requirements, prior authorization support, documentation standards, referral status updates, and closure expectations.
• Support onboarding and ongoing staff development by reinforcing approved workflows, answering process questions, providing peer guidance, and assisting with nesting support in partnership with the Patient Access Trainer and leadership.
• Assist leadership with reviewing workload needs, work queue status, referral aging, and staff workflow questions.
• Identify workflow gaps, quality concerns, training reinforcement needs, and process improvement opportunities; escalate recommendations to leadership.
• Provide feedback to the manager or director regarding team performance trends, barriers, and operational needs.
• Promote teamwork, professionalism, accountability, and consistent workflow adherence within the department.
• Ensure staff follow organizational policies, safety standards, HIPAA, privacy practices, compliance expectations, and applicable healthcare regulations.

Duties/Responsibilities:

• Provide workflow support, peer guidance, and nesting assistance to Referral Specialists in partnership with the Patient Access Trainer and leadership.
• Assist with referral intake, referral processing, documentation, authorization-related follow-up, payer communication, specialty office communication, and referral closure activities.
• Support staff with complex referral questions, missing documentation concerns, payer issues, authorization delays, status updates, and referral barriers.
• Review and route referral-related messages, documents, and work queue items necessary for referral processing.
• Help monitor referral status, referral aging, authorization status, patient outreach completion, documentation accuracy, and referral loop closure.
• Assist with escalated patient, provider, clinic, payer, or specialty office concerns related to referrals.
• Reinforce approved referral workflows, documentation standards, status reason usage, closure accuracy, and timeliness expectations.
• Support quality reviews, workflow audits, call/documentation review, and performance trend identification as requested by leadership.
• Provide feedback on department workflows, job aids, scripts, procedures, and training materials when requested by leadership or the Patient Access Trainer.
• Answer calls, respond to assigned messages, and assist with referral-related patient or department needs as appropriate.
• Attend and participate in required meetings, trainings, department activities, continuing education, and assigned initiatives.
• Perform other related duties as assigned.

Qualifications

Required Skills/Knowledge/Abilities:

• Strong knowledge of referral processing workflows, referral documentation, referral status management, and referral closure expectations.
• Knowledge of insurance eligibility, benefits, payer requirements, authorization requirements, PCP requirements, and specialty referral processes.
• Knowledge of HIPAA, privacy practices, patient confidentiality, compliance expectations, and healthcare regulations affecting the role.
• Ability to guide, support, and reinforce workflows with staff in a professional and consistent manner.
• Ability to identify workflow gaps, quality concerns, training reinforcement needs, and process improvement opportunities.
• Strong communication and interpersonal skills with the ability to work effectively with patients, staff, providers, clinic teams, specialty offices, insurance plans, and leadership.
• Ability to handle escalated concerns professionally and escalate issues appropriately.
• Strong organization, time management, problem-solving, and follow-through skills.
• Proficiency with electronic health records, referral systems, payer portals, Microsoft Office, and other department technology.
• Ability to maintain confidentiality, exercise discretion, and use sound judgment.
• Ability to speak English and Spanish preferred.

Education and Experience:

Required:

• High School Diploma or GED.
• Two or more years of experience in healthcare referrals, patient access, scheduling, customer service, call center, or related healthcare operations.

Preferred:

• Experience in an FQHC referral setting.
• Prior lead, mentoring, peer support, or workflow support experience.

Other Requirements:

• New Hires are required to pass pre-employment background check and drug testing (effective 11/1/2022).