Community Referral Specialist

JOB PURPOSE

The Community Referral Specialist will manage all incoming referrals from a selection of key referral sources. They will evaluate referrals for admission to PruittHealth leveraging clinical experience and an understanding of Home Health agencies. They will help patients obtain services by PruittHealth and support Community Relations Representatives in sustaining business partnerships with referral sources. In this cross‑functional role, the Specialist engages with partners across disciplines, from external hospitals and healthcare systems to Pruitt administrators, clinical managers, and Community Relations Representatives.

KEY RESPONSIBILITIES

Review patient referrals and respond on behalf of PruittHealth meeting productivity response expectations. Accurately complete referral documentation to facilitate the admissions process, keeping data entry error at 1% or less. Manage incoming calls and respond before the third ring. Assign the appropriate next person in the referral management process. Verify insurance and eligibility if assigned. Work closely with the clinical team until admission is scheduled. Attend morning huddle calls. Collaborate with revenue cycle team to ensure understanding of payors and requirements affecting verification/authorization. Escalate issues or barriers to manager. Review physician orders and follow up with referral source for clarifications or additional information if needed. Identify objections, concerns, or other entry barriers and provide information in response, offering alternatives if the agency is unable to provide services. Process and document referrals that are not accepted for admission, indicating specific reason for non‑acceptance. Access multiple electronic health systems to receive referrals. Understand daily agency statuses across staffing, payor, and clinical abilities and manage points of contact across assigned agencies. Partner closely with sales partners, administrators, and clinical managers. Support further processing referrals, vet payors, and conduct welcome calls when needed. Perform other related duties as necessary and directed by supervisor.

KNOWLEDGE, SKILLS, ABILITIES

Fluent with all regulatory agencies, reimbursement systems, and levels of care. Knowledgeable of private insurance and Medicare coverage criteria, rules, and regulations. Assist in the evaluation of patients to ensure they are appropriate for admission. Take responsibility for a regional territory of hospitals and community services to facilitate placements within the network of providers. Communicate referral needs within our structure and facilitate admissions into the network of providers. Provide excellent customer service to all referral sources and network of providers while supporting the Community Relations Representative. Obtain all documentation necessary to support the focus of care. Learn to use multiple electronic health systems and platforms to receive referrals. Participate in continuing educational programs, maintain current license/certification as required, and keep abreast of field changes. Honor patients/residents’ rights to fair and equitable treatment, self‑determination, individuality, privacy, property, and civil rights, including the right to wage complaints. Communicate well with patients/residents/clients and family members, providing a warm and friendly greeting and an approachable attitude, responding to expressed concerns in a professional manner. Commit to high ethical standards, comply with the Code of Conduct, state and federal regulations, accreditation standards, and policies and procedures; maintain confidentiality of patient and employee records; report compliance concerns, significant legal risk questions, fraud, abuse, or misconduct to management.

QUALIFICATIONS

Minimum Education Required: High School Diploma or equivalent Minimum Experience Required: One (1) year experience working in a healthcare environment, or any equivalent combination of experience and training that provides the required knowledge, skills, and abilities. Minimum Licensure/Certification Required by Law: n/a Additional Qualifications: Clerical and computer skills required, including experience with data entry. Knowledge of basic medical terminology. As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status. #J-18808-Ljbffr Pruitthealth Corporation