Referral Specialist

Central Florida Health Care•Winter Haven, FL

About The Position

The Referral Specialist coordinates and completes patient referrals ordered by CFHC providers. The role includes acquiring and verifying third-party information, obtaining referral appointments, securing insurance authorizations, notifying patients, documenting referral activity, and tracking referrals to support quality and continuity of care. STAT referrals must be completed by the end of the business day, urgent referrals within 24 hours, and routine referrals within 72 hours. The position reports to the Referral Specialist Supervisor and supervises no personnel. The role also requires compliance with CFHC policies and applicable state and federal regulations, cooperation with the clinical team, participation in mandatory meetings, and reporting pertinent patient-care or liability matters to the CMO as needed. Physical requirements include spending 80% or more of the time sedentary, independent mobility, and the ability to lift weights required for repositioning equipment and lifting supplies. The employee must adapt to varying workloads, patient acuity, work sites, and work shifts.

Requirements

High school graduate or GED required.
Computer literacy.
Knowledge of basic medical terminology.
Knowledge of insurance programs, such as Medicaid.
Strong customer service focus.
Effective verbal and written communication skills.
Organized and able to manage competing priorities.
Resourcefulness in problem solving.
Ability to take and follow through with delegated tasks.
Team-oriented.

Nice To Haves

Certified and Registered Medical Assistant credentials preferred.
Experience preferred.

Responsibilities

Coordinate all aspects of completing referrals ordered by CFHC providers.
Complete STAT referrals by the end of the business day, urgent referrals within 24 hours, and routine referrals within 72 hours.
Obtain insurance authorizations and send documentation from the patient’s medical record as required.
Schedule referral appointments when applicable and ensure appropriate paperwork is faxed to the specialist or provided to the patient.
Notify patients of scheduled referral appointments.
Document referral activity appropriately and thoroughly.
Track referrals, including making reminder calls to patients before appointments and obtaining reports from specialists.
Notify the ordering provider and/or Referral Specialist Supervisor of problems obtaining referrals, including authorization or scheduling issues, patient refusal, or patient no-shows.
Maintain a specialty provider list, including accepted payors.
Review the referral log weekly to ensure referrals are completed.
Comply with CFHC philosophies, policies, procedures, and applicable state and federal regulations.
Report pertinent information or situations affecting patient care or CFHC liability to the CMO as needed.
Attend and participate in mandatory CFHC and other designated meetings.
Work cooperatively with and support other clinical team members.
Maintain a neat and professional appearance.
Carry out other activities assigned by the CMO or CEO and other duties assigned by the Referral Specialist Supervisor.

Benefits

Competitive salary.
Federal Student Loan Forgiveness (PSLF): 10-year commitment and 120 loan payments, after which the remaining loan is forgiven.
Medical, dental, vision, and pharmacy benefits.
Employer-paid long-term disability insurance.
Employer-paid life insurance equivalent to one times annual salary.
Voluntary short-term disability, additional life, and dependent life insurance available.
Malpractice insurance.
Paid time off: 4.4 weeks per year, prorated.
9.5 paid holidays per year.
Paid birthday holiday.
CME reimbursement.
401(k) retirement plan after one year of service, with matching contributions.
Staff productivity is recognized and rewarded.