Referral Representative

Family HealthCare Network•Fresno, CA

10d

About The Position

The Referral Representative assists patients with referrals across multiple service lines. The role coordinates with insurance carriers to obtain pre-authorizations, verifies patient eligibility, schedules appointments with internal and external specialists, and keeps patients informed about referral status. It also prepares and submits referral packets and required documentation, processes and follows up on open referrals, coordinates surgeries and hospital pre-admissions, and responds to questions from patients and specialists. The representative uses the electronic health record system and third-party payer portals to obtain, document, and process referral information. The role monitors assigned worklists, documents referral activity, submits activity reports to a supervisor, and works with provider teams to ensure referrals are completed and closed. Additional duties include orienting new providers to the referral process, providing periodic in-services, contributing feedback to improve referral processes, meeting productivity metrics, and performing other assigned duties. The employee may be required to work at any FHCN location based on business needs.

Requirements

Effective June 1, 2026, new hires must possess work-related skills beyond high-school completion, including written and verbal communication, computational and computer, mathematical, and technical skills.
Effective June 1, 2026, new hires 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. A higher-level degree with a stronger GPA may be used as proof in lieu of the high school diploma.
Effective June 1, 2026, new hires must have health care-related knowledge frequently acquired through a trade school, para-professional, or certificate-type program.
Minimum of two years of employment experience in a health care 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.
Ability to meet the physical demands described, with reasonable accommodations available for individuals with disabilities.

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 and identify options for specialty access.
Coordinate, communicate, and schedule appointments with internal and external specialists; inform patients about the referral process and status.
Use appropriate CPT and current ICD-10 codes to meet payer and specialist office requirements.
Prepare comprehensive referral packets with orders, authorization paperwork, demographics, eligibility verification, provider notes, and relevant diagnostics or lab work.
Submit referral packets and documentation to specialists and facilitate missing information to support timely processing.
Process, follow up on, and close referrals, communicating completion to the provider team.
Respond to calls and questions from patients and specialists about referral orders and care coordination, and complete appropriate follow-up.
Coordinate surgeries with hospitals, specialists, and patients; obtain hospital pre-admissions from insurers and health plans.
Submit referral activity reports to the supervisor.
Use the electronic health record system and third-party payer or insurance portals to obtain, process, and document referral information.
Monitor assigned worklists throughout the day, capture requests in real time, and organize work according to acuity.
Document referral-processing activity, including interactions with patients, providers, and specialists.
Orient new providers and provide periodic in-services to existing providers and staff about the referral process.
Provide feedback to help streamline internal referral processes.
Meet referral productivity metrics and comply with the Attendance and Absenteeism Policy.
Be able to present to and work at any FHCN location based on business need.
Perform other duties as assigned.