Referral Specialist

HEART OF FLORIDA HEALTH CENTER INC•Ocala, FL

1d•Onsite

About The Position

The Referral Specialist is responsible for coordinating, processing, and tracking all referrals for specialty, diagnostic, and ancillary services. This position ensures referrals are completed accurately, timely, and in compliance with payer and regulatory requirements. In addition to referral coordination, the Referral Specialist manages associated documentation, supports patient navigation, and serves as a liaison between patients, providers, and external partners.

Requirements

High School diploma or equivalent required
Minimum two (2) years of experience in referrals, authorizations, insurance verification, or healthcare administration required.
Knowledge of medical terminology, referral workflows, and payer requirements.
Proficiency with Electronic Health Records (e.g., eClinicalWorks, Epic) and Microsoft Office Suite.

Nice To Haves

Associate degree in health services, medical office administration, or related field preferred.
Bilingual (English/Spanish/Creole) preferred, depending on patient population served.

Responsibilities

Receive, process, and document all provider-initiated referrals in the Electronic Health Record (EHR).
Collect and assemble supporting documentation (labs, imaging, progress notes) to send with referrals.
Verify insurance eligibility, secure prior authorizations/pre-certifications, and confirm medical necessity as required.
Notify providers promptly of referral denials or delays and follow escalation protocols.
Track referrals until completion, ensuring results are received and routed back to the ordering provider.
Monitor payer requirements and maintain current knowledge of referral/authorization rules.
Retrieve and route incoming faxes, scanned documents, and electronic records to the appropriate patient chart.
Ensure proper indexing, naming conventions, and documentation closure within the EHR.
Maintain referral logs, reports, and supporting documentation for audit readiness.
Respond to internal requests for records related to referrals and coordinate release-of-information activities in line with HIPAA and organizational policies.
Forward court-ordered requests to the designated Quality/Risk representative.
Support billing accuracy by ensuring documentation aligns with payer requirements.
Educate patients and families about referral requirements, appointment instructions, and expectations.
Identify and address barriers to care (transportation, financial hardship, language access, interpreter services).
Coordinate with external specialists, hospitals, and diagnostic facilities to schedule or confirm appointments.
Follow up with patients to ensure appointments are kept and results are returned.
Serve as a consistent point of contact for patients/families with questions or concerns related to referrals.
Maintain collaborative relationships with community resources and partner providers.
Adhere to HIPAA and organizational policies related to confidentiality, release of information, and documentation.
Support HRSA, NCQA PCMH, and payer compliance requirements for referrals and continuity of care.
Participate in audits, quality improvement projects, and departmental process evaluations.
Contribute to organizational goals by tracking and reporting referral-related Key Performance Indicators (KPIs), including timeliness, completion rates, and patient satisfaction.
Perform additional duties as assigned by the Referral Ops Manager, Dir of Operations, or designee.
Support cross-coverage for team members during absences or peak workload periods.