Referral Representative

Family HealthCare Network•Strathmore, CA

9d•$25 - $30

About The Position

The Referral Representative assists patients with completing referrals across multiple service lines. The role coordinates with insurance carriers to obtain pre-authorizations, verifies patient eligibility, arranges appointments with internal and external specialists, and keeps patients informed about referral progress. The representative prepares and submits comprehensive referral packets and documentation, ensures accurate CPT and ICD-10 coding, tracks open referrals through completion, coordinates surgeries and hospital pre-admission requirements, and submits referral activity reports to a supervisor. The position uses an electronic health record system and third-party payer portals to retrieve and document information, monitor and prioritize referral worklists, record interactions, follow referrals through closure, and meet referral productivity metrics. It also provides orientation and in-services on referral procedures and contributes feedback to improve internal processes. The employee must adhere to attendance requirements and may be assigned to any FHCN location based on business needs. Other duties may be assigned. Effective June 1, 2026, new hires must meet the stated education and healthcare experience requirements. The position requires written and verbal communication, computer and technical skills, and the ability to convey technical information to non-technical audiences. Medical Assistant certification is preferred. The role regularly involves sitting and repetitive hand movements for typing and grasping, frequently involves standing or walking, and occasionally requires lifting or moving up to 20 pounds.

Requirements

Effective June 1, 2026, must have work-related skills beyond high school completion, including formal written and verbal communication, computational and computer, mathematical, and technical skills.
Effective June 1, 2026, must provide proof of high school completion with a minimum overall GPA of 2.5, or GED completion with a minimum overall score of 162.5, and have healthcare-related knowledge commonly acquired through a trade school, paraprofessional, or certificate-type program.
If the individual has completed a degree higher than the role requires and earned a stronger GPA in that program, proof of that degree's GPA may be provided in lieu of the high school diploma.
Effective June 1, 2026, must have at least two years of employment experience in a healthcare setting.
Ability to prepare complex Microsoft Word documents, including tables, charts, graphs, and other elements.
Ability to use Microsoft Excel to review and compile data, including formulas, functions, lookup tables, and other standard spreadsheet elements.
Ability to create basic Microsoft PowerPoint presentations.
Ability to compile information into effective written materials, including correspondence, reports, articles, or other documentation.
Ability to convey technical information effectively to non-technical audiences.
Meet the physical demands of the role, with reasonable accommodations available as described.

Nice To Haves

Medical Assistant certification preferred.

Responsibilities

Assist patients with completing referrals across multiple service lines.
Coordinate with insurance carriers to obtain pre-authorizations for specialty services.
Verify patient eligibility to determine specialty-access options.
Coordinate, communicate, and schedule appointments with internal and external specialists, and inform patients about the process and referral status.
Use appropriate CPT and current ICD-10 codes to meet payer and specialty-office requirements.
Prepare comprehensive referral packets, including referral orders, pre-authorization paperwork, patient demographics, eligibility verification, primary care provider notes, and relevant diagnostics or lab work.
Submit referral packets and supporting documentation to specialists for timely processing.
Process open referrals efficiently and promptly, facilitate obtaining missing information, and ensure referrals are closed and communicated to the provider team.
Respond to patient and specialist calls and questions about referral orders and care coordination, and ensure appropriate follow-up.
Coordinate surgeries with hospitals, specialists, and patients, and obtain hospital pre-admission authorization from health insurers and plans.
Submit referral activity reports to the supervisor.
Use the electronic health record system to obtain and document necessary information.
Monitor assigned worklists throughout the day, capture referral requests in real time, and organize work based on acuity.
Document referral-processing activity, including interactions with patients, providers, and specialists.
Use third-party payer and insurance portals to process referral orders.
Follow up on the entire referral process, including closing referrals.
Orient new providers and provide periodic in-services to existing providers and staff on the referral process.
Provide feedback on process analysis to streamline internal referral processes.
Meet specific referral productivity metrics.
Adhere to the Attendance and Absenteeism Policy and regular attendance requirements.
Work at any FHCN location at the beginning of or during a shift when business needs require.
Perform other duties as assigned.