Referral Operations Manager

HEART OF FLORIDA HEALTH CENTER INC•Ocala, FL

4d•Onsite

About The Position

The Referral Operations Manager oversees all aspects of the referral management process across Heart of Florida Health Center (HFHC) sites. This position ensures timely, accurate, and patient-centered coordination of specialty referrals, fosters strong relationships with internal and external providers, and promotes a closed-loop referral process to improve continuity of care. The Manager leads referral staff, standardizes workflows, monitors key performance indicators (KPIs), and collaborates with clinical and operations leaders to remove barriers and improve patient access. This role requires a balance of hands-on oversight, data-driven management, and mentorship to staff, ensuring excellence in service delivery and compliance with payer and organizational requirements.

Requirements

Associate’s Degree required; Bachelor’s Degree in Healthcare Administration, Business, or related field preferred.
Minimum of 3 years in healthcare referral coordination or patient access roles.
Minimum of 1–2 years of supervisory or lead experience.
Strong leadership, organizational, and problem-solving skills.
Excellent communication and interpersonal abilities, including cultural sensitivity.
Proficiency in electronic health records (EHR), referral tracking tools, and Microsoft Office Suite.
Working knowledge of insurance plans, ICD-10/CPT coding basics, and prior authorization processes.
Ability to manage competing priorities and adapt in a fast-paced environment.

Nice To Haves

Experience in Federally Qualified Health Centers (FQHCs) or multi-site ambulatory care preferred.
Medical Assistant (MA) or Licensed Practical Nurse (LPN) certification preferred but not required.
Bilingual (English/Spanish) preferred.

Responsibilities

Leads, trains, and evaluates Referral Specialists; provides regular coaching and performance feedback.
Develops staffing schedules, manages workload distribution, and ensures appropriate coverage across locations.
Promotes a culture of accountability, teamwork, and continuous improvement aligned with HFHC’s mission and values.
Serves as the primary escalation point for complex referral issues and patient concerns.
Oversees daily referral operations to ensure accuracy, timeliness, and compliance with payer authorization requirements.
Monitors open referral queues and works with clinical teams to achieve closed-loop documentation.
Coordinates post-hospitalization follow-up and transition of care referrals.
Reviews denials and works with staff and payers to resolve barriers.
Ensures staff maintain current knowledge of payer rules, prior authorization requirements, and documentation standards.
Collaborates with IT and Operations on process enhancements within the EMR (e.g., tracking logs, dashboards, templates).
Develops and tracks referral-related KPIs, including turnaround times, closure rates, and patient satisfaction.
Identifies process bottlenecks and leads quality improvement initiatives to optimize efficiency.
Provides data and reports for Quality Management, Operations, and Compliance teams.
Assures compliance with HFHC policies, HRSA guidelines, and HIPAA regulations.
Acts as liaison between referral staff, clinical teams, and external specialists to coordinate care.
Participates in cross-departmental meetings to align referral processes with organizational goals.
Maintains positive working relationships with external specialists, imaging centers, and hospitals to facilitate patient access.
Accurate entry and management of referral and document data.
Professional and clear interactions with patients, providers, and external partners.
Ability to resolve barriers and adapt to complex referral or payer challenges.
Works effectively with clinical staff, front desk, case managers, and external providers.
Demonstrates respect and responsiveness to diverse populations.
Maintains strict adherence to HIPAA and privacy rules.
Ensures average referral turnaround time meets organizational standards.
Ensures referral closure and documentation rate is greater than organizational standards.
Maintains patient satisfaction with referral coordination.
Maintains compliance with payer and audit requirements
Ensures effective communication and timely escalation of issues.
Performs other duties as assigned.