Referral Specialist

Premier Community Healthcare Grp.•Dade City, FL

17d

About The Position

The Referral Specialist manages a high volume of referrals and pre-authorizations for multiple providers. The role collaborates with other referral specialists, patient service representatives, clinical staff, health plans, providers, and patients to ensure referrals are processed accurately and efficiently. The Referral Specialist serves as a key liaison in supporting timely access to specialty and additional care services. The position requires maintaining confidentiality and complying with HIPAA requirements, communicating workflow disruptions that affect patient flow, supporting community give-back initiatives, advocating for Premier’s mission, adhering to its core values and patient care standards, and participating in departmental goals and QI/QA activities. Other duties may be assigned.

Requirements

High school diploma or GED.
Basic understanding of medical terminology and clinical documentation.
Ability to perform repetitive tasks accurately and with attention to detail.
Basic mathematical skills.
Strong customer service skills, empathy, and compassion.
Ability to communicate clearly and professionally, verbally and in writing.
Excellent grammar, spelling, and interpersonal skills.
Professional demeanor, strong work ethic, and positive attitude.
High ethical standards and strict adherence to confidentiality and Premier values.
Ability to obtain and maintain Epic certification and complete annual compliance training.

Nice To Haves

Two years of experience in insurance verification or a healthcare environment preferred.

Responsibilities

Assist with patient referrals for additional services at internal and external medical facilities.
Process referrals accurately, efficiently, and in a timely manner.
Communicate with providers and patients about referral status and barriers.
Contact insurance carriers to generate referrals and submit required clinical documentation.
Enter referral data into the practice management system.
Provide required documentation to specialty provider offices before appointments.
Educate patients about referral requirements and responsibilities.
Request and process insurance authorizations and forward approvals to specialty providers.
Scan and upload referral documentation into patient charts.
Close expired referrals and follow up on pending referrals, including sending letters to non-compliant patients.
Maintain confidentiality and comply with HIPAA requirements.
Communicate workflow disruptions that affect patient flow to care team members.
Support community give-back initiatives and advocate for Premier’s mission.
Adhere to Premier’s core values and patient care standards to ensure an excellent patient experience.
Participate in departmental goals and Quality Improvement / Quality Assurance (QI/QA) activities.
Perform other duties as assigned.