Patient Referral Specialist

HCA Healthcare • Plano, TX

1d

About The Position

The Patient Referral Specialist processes physician, hospital, and outpatient referrals and coordinates patient scheduling, insurance authorization, and guidance about insurance coverage. The role works with diagnostic and surgical service areas, physician offices, hospitals, and managed-care representatives to ensure referrals and appointments are handled accurately and promptly.

The specialist enters and maintains patient and referral information in the electronic medical record (EMR) or other designated programs, obtains medical records and valid provider orders, confirms insurance eligibility and authorizations, and communicates appointment and preparation details to patients or family members. The role also documents appointments and procedures, coordinates follow-up, closes referral processes, and reports referral volume and status to practice leadership.

This is a full-time, Monday–Friday daytime position with no nights, on-call, weekends, or holidays. The position requires a high school diploma or GED and one year of referral coordination experience related to insurance provider tiers, authorizations, and out-of-network procedures. No certification or license is required.

Requirements

• High school diploma or GED equivalent.
• One year of experience in referral coordination related to insurance provider tier levels, insurance authorizations, and out-of-network procedures.

Responsibilities

• Process physician, hospital, and outpatient referrals.
• Schedule patients and provide appropriate guidance regarding insurance coverage.
• Collaborate with diagnostic and surgical service areas, physician offices, and hospitals to ensure appointments, tests, and procedures are scheduled accurately and promptly.
• Provide accurate patient demographic and pertinent medical information to support patient safety and quality care.
• Determine insurance eligibility and authorization for medical office and surgical visits, or coordinate with the authorization coordinator to ensure payor authorizations are received.
• Initiate EMR records by entering demographics, referring and certifying physicians, and family information; obtain needed medical records from referring providers.
• Build working relationships with offices, hospital personnel, and managed-care representatives.
• Use the EMR or other designated programs to capture and track referrals.
• Obtain accurate and valid physician or advanced practitioner orders for scheduled appointments, tests, and procedures.
• Communicate appointment, test, procedure, and preparation information to patients or family members.
• Adhere to privacy, compliance, and HIPAA regulations.
• Ensure patients have appropriate follow-up appointments with physicians to discuss outcomes.
• Accurately document appointment, test, scan, and procedure dates and times in the patient's medical record.
• Communicate with practice staff as appropriate and ensure the referral process is completed and closed.
• Submit outgoing referrals the same day, preferably while patients are present, to support timely appointment scheduling.
• Provide weekly reports to practice leadership on referral volume, status, and follow-up on outstanding appointments.
• Perform related work and adhere to the Code of Conduct and Mission and Value Statements.

Benefits

• Comprehensive medical, prescription drug, dental, vision, behavioral health, and telemedicine benefits.
• Wellbeing support, including free counseling and referral services.
• Paid time off, paid family leave, long- and short-term disability coverage, and leaves of absence.
• 401(k) plan with a 100% match on 3% to 9% of pay, based on years of service.
• Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support, and financial wellbeing counseling.
• Tuition assistance, student loan assistance, certification support, dependent scholarships, and a partnership with Galen College of Nursing.
• Fertility and family-building benefits and adoption assistance.
• Life insurance and supplemental health protection plans.
• Auto and home insurance, legal counseling, identity theft protection, and consumer discounts.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED