Referral Specialist

Physicians’ Primary Care•Fort Myers, FL

14d

About The Position

The Referral Specialist processes outgoing patient referrals, including entering referral orders with physician approval, verifying in-network referral destinations, faxing referrals with pertinent medical documentation, and documenting referral activity in the patient’s electronic medical record. The role also obtains authorizations for specialist office visits through applicable payer portals when requested. The position reports to the Site Supervisor and has no supervisory responsibilities. The Referral Specialist provides customer service to internal and external customers, coordinates referral details with nurses and medical assistants for physician review, confirms that referrals are accurately ordered and directed to appropriate providers, and sends supporting records to specialist offices within 72 business hours. The role handles patient and specialist-office inquiries about referral status, authorization requests, and documentation, and maintains timely records of referral and authorization activity.

Requirements

High school graduation or GED.
One year of work experience; preferably in a medical office setting.
Word-processing and computer experience.
Knowledge of business office procedures.
Knowledge of grammar, spelling, and punctuation for typing patient information.
Ability to operate a computer and photocopy machine.
Ability to answer the telephone in a pleasant and helpful manner.
Ability to speak clearly and concisely.
Ability to read, understand, and follow oral and written instructions.
Ability to sort and file materials correctly using alphabetical or numeric systems.
Ability to establish and maintain effective working relationships with patients, employees, and the public.

Nice To Haves

Knowledge of medical terminology.
Medical office work experience.

Responsibilities

Provide friendly, courteous, and helpful customer service to internal and external customers.
Receive referral requests from specialist offices and communicate diagnosis and referral details to nurses or medical assistants for physician review and referral ordering.
Ensure referrals are accurately ordered in the EMR before processing, and review the diagnosis and specialty for a suitable match. Family Practice referrals must be ordered by a physician or nurse; Pediatric Referral Specialists may enter orders with physician approval.
Verify the appropriate specialist destination and direct referrals to in-network providers when applicable.
Fax referrals and pertinent supporting medical records, including clinical notes, lab results, and diagnostic imaging, to the appropriate specialist office within 72 business hours.
Obtain authorization for specialist office visits upon request using applicable insurance provider portals.
For STAT referrals, notify patients of the specialist or provider and provide the specialist office phone number so patients can schedule appointments.
Answer incoming calls and review voicemail throughout the day to respond to patients and specialist offices about referral status, authorization requests, and related documentation needs.
Maintain accurate and timely referral documentation, record appointment dates in the Outgoing Referral section of the patient hub, and complete referral and authorization activity efficiently.
Communicate with nurses and medical assistants through internal messaging to request additional referral details and provide information for physician review and approval.