Referral Specialist

Referral Specialist

Join us and be part of a mission-driven team that prioritizes innovation, collaboration, and continuous development. Under the direction of the Supervisor, Referrals, the Referrals Specialist serves as a primary interface between patients, providers, offices, medical facilities, and community agencies. This position coordinates outgoing and off-site referrals, including imaging orders, by assisting and advocating to ensure patients are appropriately notified and scheduled for services. The role also monitors and manages deferred referrals to ensure timely receipt of referral and order documentation for quality compliance.

Duties/Responsibilities:

• Navigate and manage patient charts and clinical documentation within Epic EMR.
• Coordinate referrals and imaging orders using Epic and insurance portals.
• Verify eligibility and obtain prior authorizations/pre-certifications as needed.
• Route/fax medical documentation electronically and retrieve reports via RHIO.
• Track referral status and assist patients with scheduling appointments.
• Follow up on missed referral/imaging appointments.
• Communicate appointment details and preparation requirements to patients.
• Collaborate with Care Managers and other departments to resolve barriers.
• Ensure HIPAA compliance and maintain confidentiality of PHI.
• Perform other duties as assigned.

Required Skills/Abilities:

• Proficiency in Epic EMR and Microsoft Office Suite.
• Strong knowledge of medical terminology and HIPAA regulations.
• Excellent customer service, organizational, and time management skills.
• Ability to multi-task and problem-solve effectively.
• Strong written and verbal communication skills; bilingual preferred.

Education and Experience:

• High School Diploma or equivalent required.
• Minimum 3 years in a medically based or human services setting.
• At least 2 years of EMR experience; Epic required.
• Knowledge of insurance carriers, prior authorizations, and community resources.
• Valid NYS Insurance Assister certificate preferred (or obtain within 6 months).

Physical Requirements:

While performing the duties of this job, the employee is regularly required to sit, stand, walk, and communicate effectively. Occasional bending, lifting up to 25 pounds, and other physical activities may be required.

Equal Employment Opportunity:

Trillium Health promotes Equal Employment Opportunity for all, respecting diverse backgrounds, cultures, races, ages, experiences, and opinions. Employees must meet department performance standards and participate in compliance audits, process improvement, and quality improvement plans.