Referral Representative

Family HealthCare Network•Visalia, CA

3d•$25 - $30

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 communicates referral status and next steps to patients. It ensures accurate use of CPT and current ICD-10 codes and prepares and submits comprehensive referral packets, including orders, authorization documents, patient demographics, eligibility verification, provider notes, and relevant diagnostics or lab work. The representative monitors and processes open referrals, addresses missing information, follows referrals through completion, and communicates closure to the provider team. The position also responds to questions from patients and specialists and coordinates surgeries with hospitals, specialists, and patients, including obtaining hospital pre-admission authorization. The representative uses the electronic health record and insurance portals to capture, organize, and document referral activity, monitors assigned worklists throughout the day, and works according to referral acuity and productivity metrics. The role includes orienting new providers and providing periodic in-services to providers and staff, offering feedback to improve referral processes, and submitting referral activity reports to a supervisor. Regular attendance is an essential function. The employee must be able to work at any FHCN location at the beginning of or during a shift based on business needs and perform other duties as assigned.

Requirements

As of June 1, 2026, possess work-related skills above high-school completion, including formal written and verbal communication, computational and computer, mathematical, and technical skills.
As of June 1, 2026, 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 health care-related knowledge commonly acquired through a trade school, paraprofessional, or certificate-type program.
If a degree higher than the role’s stated education level has a stronger GPA, proof of GPA from that degree may be provided in lieu of the high school diploma.
As of June 1, 2026, have at least two years of employment experience in a health care setting.
Prepare complex Microsoft Word documents, including tables, charts, graphs, and other elements.
Use Microsoft Excel to review and compile data, including formulas, functions, lookup tables, and other standard spreadsheet elements.
Create basic Microsoft PowerPoint presentations.
Compile information into effective written correspondence, reports, articles, or other documentation.
Effectively convey technical information to non-technical audiences.
Meet the position’s physical demands, including sitting, repetitive hand movement for typing and grasping, frequently standing or walking, and occasionally lifting or moving up to 20 pounds; reasonable accommodations may be made.

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