Care Management Referral Specialist

Referral Specialist
Location-Dade City

General Description
The Referral Specialist manages a high volume of referrals and pre-authorizations for multiple providers. This role collaborates closely with other referral specialists, patient service representatives, clinical staff, health plans, providers, and patients to ensure referrals are processed accurately and efficiently. The Referral Specialist serves as a key liaison to support timely access to specialty and additional care services.

Essential Duties & Responsibilities

Assist with patient referrals for additional services with internal and external medical facilities

Ensure referrals are processed accurately, efficiently, and in a timely manner

Communicate with providers and patients regarding referral status and any barriers

Contact insurance carriers to generate referrals and submit required clinical documentation

Enter referral data into the practice management system

Provide required documentation to specialty provider offices prior to appointments

Educate patients on referral requirements and responsibilities

Request and process insurance authorizations and forward approvals to specialty providers

Scan and upload referral documentation into patient charts

Close expired referrals and follow up on pending referrals, including sending letters to non-compliant patients

Maintain confidentiality and comply with HIPAA requirements at all times

Communicate workflow disruptions that impact patient flow to care team members

Support community give-back initiatives and advocate for Premier’s mission

Adhere to Premier’s core values and patient care standards to ensure an excellent patient experience

Participate in departmental goals and Quality Improvement / Quality Assurance (QI/QA) activities

Perform other duties as assigned

Knowledge, Skills & Abilities

Basic understanding of medical terminology and clinical documentation

Ability to perform repetitive tasks with accuracy and attention to detail

Basic mathematical skills

Strong customer service skills with empathy and compassion

Ability to communicate clearly and professionally, verbally and in writing

Excellent grammar, spelling, and interpersonal skills

Professional demeanor, strong work ethic, and positive attitude

High ethical standards with strict adherence to confidentiality and Premier values

Qualifications

High School Diploma or GED required

Two (2) years of experience in insurance verification or a healthcare environment preferred

Ability to obtain and maintain Epic certification and annual compliance training

Working Conditions & Physical Requirements

Ability to lift 20 lbs. regularly and 30-50 lbs. occasionally

Ability to sit for extended periods

Direct exposure to computer screens

Possible exposure to contagious or infectious diseases

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