Referral Specialist - Spring Hill Port Royal - Days Mon.-Fri. 7:30AM-4:00PM

Williamson Health•Franklin, TN

5d•Onsite

About The Position

The Referral Specialist coordinates all aspects of the referral process for assigned clinics, ensuring referrals are processed promptly, accurately, and completely. The role provides customer service to patients, providers, specialists, and insurance carriers and serves as the primary liaison throughout the process to support continuity of care and compliance with organizational policies, payer requirements, and regulatory standards. The position is based in the assigned clinic during scheduled work hours and works directly with providers, nurses, medical assistants, front office staff, and other departments. The Referral Specialist processes prior authorizations for medications, diagnostic testing, procedures, and referrals; gathers clinical documentation; communicates request status and information needs; and monitors pending requests through resolution. The role also documents referral and authorization activity in the Electronic Medical Record (EMR), supports workflow improvements, participates in team meetings and training, and may assist with orienting new referral staff. Other duties may be assigned by the Practice Manager or Referral Coordinator.

Requirements

High school diploma or General Education Degree (GED).
At least two years of experience in a medical office or healthcare setting.
Strong customer service and communication skills.
Ability to operate a computer and EMR software, multi-line telephone system, printer/copier/scanner, fax machine, Microsoft Office applications, and standard office equipment.

Nice To Haves

Associate degree or healthcare-related coursework.
Experience with referrals, prior authorizations, insurance verification, or care coordination.
Knowledge of medical terminology.
Experience using Electronic Medical Record (EMR) systems.

Responsibilities

Coordinate the referral process for assigned clinic(s), ensuring timely, accurate, and complete processing.
Serve as the primary liaison among patients, providers, specialists, and insurance carriers throughout the referral process.
Process prior authorizations for medications, diagnostic testing, procedures, and referrals as required by insurance carriers.
Review insurance requirements and gather clinical documentation to support medical necessity for prior authorization requests.
Communicate with providers, clinical staff, pharmacies, insurance companies, and patients about prior authorization status and additional information needed.
Document referral and prior authorization activities, approvals, denials, and follow-up actions accurately and completely in the EMR.
Monitor pending prior authorizations, notify providers of denials, and facilitate appeals or requests for additional documentation when appropriate.
Maintain compliance with organizational policies, HIPAA regulations, payer requirements, and referral management standards; protect confidential patient information.
Keep current with insurance requirements, referral guidelines, payer-specific authorization requirements, formulary changes, regulatory updates, and EMR workflow changes.
Assist in developing and improving referral workflows to increase efficiency and patient satisfaction.
Respond promptly to patient, provider, and specialist inquiries while maintaining efficient referral workflows.
Collaborate with clinic providers, nurses, medical assistants, front office staff, and other departments to facilitate timely patient care.
Participate in department meetings, education, training, daily operations, and process improvement initiatives.
Assist with orientation and training of new referral staff as requested.
Maintain regular and reliable attendance and punctuality and be physically present in the assigned clinic during scheduled work hours.
Perform other duties as assigned by the Practice Manager or Referral Coordinator.