Referral Specialist

Premier Community Healthcare Grp.•Dade City, FL

5d•Onsite

About The Position

The Referral Specialist manages a high volume of referrals and pre-authorizations for multiple providers. This role collaborates closely 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 to support timely access to specialty and additional care services.

Requirements

Basic understanding of medical terminology and clinical documentation
Ability to perform repetitive tasks with accuracy and attention to detail
Basic mathematical skills
Strong customer service skills with 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 with strict adherence to confidentiality and Premier values
High School Diploma or GED required
Ability to obtain and maintain Epic certification and annual compliance training

Nice To Haves

Two (2) years of experience in insurance verification or a healthcare environment preferred

Responsibilities

Assist with patient referrals for additional services with internal and external medical facilities
Ensure referrals are processed accurately, efficiently, and in a timely manner
Communicate with providers and patients regarding referral status and any 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 prior to appointments
Educate patients on 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 at all times
Communicate workflow disruptions that impact 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