Referral Management Specialist

Referral Management Specialist

The compensation range listed reflects the range Northern Light Health anticipates relying on in setting the wages for the position. The range may not necessarily include all additional compensation elements available, such as differentials, incentive programs and benefits.

The Referral Management Specialist is a key member of a centralized, coordinated team responsible for supporting all referral-related activities and facilitating seamless care coordination across the Northern Light Health system. The Specialist manages the end-to-end referral process, including prior authorizations, ambulatory orders, and the scheduling of appointments and procedures, with a focus on minimizing delays, preventing denials, and optimizing access to care.

This role requires applied knowledge of medical terminology, CPT and ICD-10 coding concepts, payer-specific authorization requirements, and electronic medical record (EMR) and operating room (OR) scheduling systems. Acting as a critical liaison across the care continuumincluding primary care, specialty practices, operating rooms, ancillary departments, leadership teams, and insurance carriersthe Specialist supports clinical efficiency, protects organizational revenue, and enhances patient experience.

Operating in a fast-paced, high-volume environment, the Referral Management Specialist independently prioritizes multiple competing demands across providers and locations while maintaining accuracy, compliance, and responsiveness. The role involves frequent oral and written communication with patients, providers, and internal stakeholders at all levels of the organization.

Throughout all responsibilities, the Specialist consistently models Northern Light Health's core values of Integrity, Respect, Accountability, and Compassion, contributing to high-quality, coordinated, and patient-focused care delivery.

Responsibilities:

• Monitor EMR referral queues and Multi Patient Task Lists (MPTLs) in real time; capture, review, and process outgoing and incoming referrals and orders.
• Prepare, submit, and track prior authorizations for diagnostics, procedures, surgeries, and specialty services per payer rules.
• Schedule surgical cases and appointments as necessary, leveraging both EMR and OR scheduling platforms and evaluating room and resource allocation and utilization.
• Serve as liaison among patients, referring providers, specialty offices, insurers, and ancillary departments to resolve issues and expedite care. Including but not limited to: communicating referral/scheduling status, next steps, and preparation instructions with clarity and compassion.
• Utilize payer portals; maintain current knowledge of Medicare and commercial plan rules, inpatient vs. outpatient status, and benefit limitations.
• Other Duties

Other Information:

• Working knowledge of CPT/ICD-10 coding, HIPAA regulations, payer authorization rules, and inpatient vs. outpatient distinctions.
• Proficiency with EMR/EHR workflows, OR scheduling platforms and payer portals.
• Exceptional communication, customer service, and organizational skills.
• Ability to work independently and meet productivity standards.
• 2+ years in medical office, care access, referrals/prior auths, scheduling, or surgical scheduling; OR an associate degree in healthcare administration, business, HIM, medical coding, or related field.

Education:

• Required Associate's Degree In lieu of education, two years of experience is required per year of required education, exclusive of the minimum experience identified above.

Required Experience:

• 2 year/years of Relevant Work Experience

Working Conditions:

• Potential exposure to abusive and/or aggressive people.
• Potential exposure to noise levels being uncomfortable.
• Work with computers, typing, reading or writing.
• Prolonged periods of sitting.
• Lifting, moving and loading less than 20 pounds.

As an integrated health delivery system serving Maine, Northern Light Health is raising the bar with no-nonsense solutions that are leading the way to a healthier future for our state. Our care teamin hospitals, primary and specialty care practices, long-term and home healthcare, behavioral healthcare, and ground and air medical transport and emergency careare committed to making healthcare work for you: our patients, communities, and employees.

Questions? Contact Talent Acquisition: phone: View phone number on click.appcast.io email: View email address on click.appcast.io

Equal Opportunity Employment

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sex, sexual orientation, gender identity, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.