Health Plan Referral Specialist

Med Center Health Contact Center Referral Specialist
This opportunity is part of the NEW Med Center Health Contact Center. Med Center Health is launching a centralized Contact Center that will serve as a single point of contact for patient scheduling, insurance authorization, and financial clearance services. This innovative approach will simplify the patient journey, improve access to care, and enhance the overall patient experience.
Position Summary
The Referral Specialist serves as a point of contact for patients, providers, and internal departments to coordinate referrals across the health system. This position is responsible for receiving, processing, and managing referrals to ensure timely access to care while providing exceptional customer service. The Referral Specialist verifies referral requirements, obtains necessary authorizations when applicable, schedules appointments, and maintains accurate documentation in the electronic health record (EHR). This role requires strong communication, organizational, and problem-solving skills to effectively manage a high-volume workload in a fast-paced contact center environment.
Minimum Qualifications

Experience in healthcare, referral coordination, insurance verification, prior authorizations, patient access, revenue cycle, or a related field preferred
High School Diploma or GED preferred.
Knowledge of medical terminology, healthcare insurance plans, and payer authorization requirements preferred.
Knowledge of prior authorization processes and reimbursement practices preferred.
Strong verbal and written communication skills.
Strong organizational skills and attention to detail.
Ability to manage multiple priorities and meet established deadlines.
Ability to work effectively with patients, providers, clinical staff, and payer representatives.
Proficiency with computer systems and standard office software applications.
Experience with Epic or similar electronic health record systems preferred.
Key Responsibilities

Receives and processes incoming referrals from providers, patients, and external healthcare organizations through multiple communication channels, including phone, fax, electronic work queues, and online portals.
Reviews referrals for completeness and accuracy, ensuring all required documentation, insurance information, and provider orders are obtained prior to scheduling.
Coordinates appointments with the appropriate specialty, provider, or service based on referral guidelines and clinical requirements.
Verifies insurance eligibility and referral requirements and obtains prior authorizations or additional documentation as needed.
Communicates with referring providers, patients, and internal departments regarding referral status, scheduling updates, and outstanding requirements.
Documents all referral activities, patient interactions, and communications accurately and timely within the electronic health record.
Monitors referral work queues to ensure referrals are processed within established service level expectations and organizational standards.
Identifies and resolves referral issues by collaborating with clinical staff, provider offices, insurance companies, and other departments.
Educates patients regarding referral requirements, appointment preparation, and available resources to promote a positive patient experience.
Maintains knowledge of payer requirements, referral workflows, scheduling protocols, and organizational policies.
Demonstrates professionalism, empathy, and exceptional customer service during all patient and provider interactions.
Protects patient privacy by maintaining confidentiality of protected health information in accordance with HIPAA and organizational policies.
Participates in departmental meetings, quality improvement initiatives, and ongoing training to enhance referral processes and customer service.