Referral Specialist

Referral Specialist

Department: Nursing
Reports To: Director of Nursing
PositionSummary
The Referral Specialist coordinatespatient referrals to specialty providers and ancillary services to ensuretimely access to medically necessary care. This position works closely withproviders, patients, specialists, hospitals, and insurance companies to obtainreferrals, authorizations, and appointments while promoting continuity of care.The Referral Specialist serves as a resource for patients throughout thereferral process and helps ensure referrals are completed accurately andefficiently.
Essential Duties andResponsibilities
• Coordinate and process referrals to specialists,diagnostic testing, and ancillary services in accordance with HCPSC policiesand provider orders.
• Obtain prior authorizations and insuranceapprovals required for specialty services, procedures, and diagnostic testing.
• Schedule referral appointments and communicateappointment details, preparation instructions, and follow-up information topatients.
• Collaborate with providers, specialists,hospitals, and insurance companies to facilitate timely referral processing andcontinuity of care.
• Track referral status to ensure appointments arecompleted and consultation reports are received and incorporated into thepatient's Electronic Health Record (EHR).
• Verify and update patient demographic,insurance, and referral information to ensure accurate processing.
• Maintain accurate documentation of referrals,authorizations, communications, and patient follow-up activities within theElectronic Health Record (EHR).
• Respond to patient questions regardingreferrals, authorizations, and specialty appointments while providing excellentcustomer service.
• Assist with resolving referral, insurance, andbilling issues related to specialty care.
• Maintain patient confidentiality and protecthealth information in accordance with HIPAA and organizational policies.
• Participate in required trainings, staffmeetings, and quality improvement initiatives.
• Perform other duties as assigned.
Education & Experience
• High school diploma or equivalent required.
• Certified Medical Assistant (CMA or CCMA)certification preferred but not required.
• Minimum of two (2) years of experience inreferral coordination, medical office operations, patient access, carecoordination, or a related healthcare setting preferred.
• Experience obtaining prior authorizations,insurance verification, or coordinating specialty referrals preferred.
• Experience working in a Federally QualifiedHealth Center (FQHC) or community health center preferred.
• Experience using Electronic Health Record (EHR)systems preferred.
Knowledge, Skills, and Abilities
• Knowledge of referral coordination, priorauthorization processes, insurance verification, and medical terminology.
• Knowledge of HIPAA regulations and the abilityto maintain the confidentiality, security, and integrity of patientinformation.
• Strong organizational, communication, andcustomer service skills with the ability to manage multiple priorities in afast-paced healthcare environment.
• Proficiency in Microsoft Office and ElectronicHealth Record (EHR) systems.
• Ability to collaborate effectively withproviders, specialists, hospitals, insurance companies, and interdisciplinaryhealthcare teams.
• Ability to exercise sound judgment, solveproblems effectively, and maintain accurate documentation.