Specialist: Referral

Pagosa Springs Medical Center•Pagosa Springs, CO

5d•$18 - $22•Hybrid

About The Position

Pagosa Springs Medical Center (PSMC) is seeking a detail-oriented and patient-focused Referral Specialist to join our Rural Health Clinic team. The Referral Specialist serves as a vital link between patients, primary care providers, specialty providers, and insurance carriers. This role is responsible for processing referrals, verifying patient and insurance information, coordinating required documentation, obtaining authorizations when needed, and tracking referrals from initiation through completion. The Referral Specialist helps ensure patients experience a seamless transition of care while maintaining accurate documentation within the electronic health record.

Requirements

High school diploma or equivalent required
Minimum of two (2) years of experience in a clinical setting preferred
Previous outpatient clinic or physician office experience preferred
Previous clinical experience preferred but not required
Previous electronic medical record (EMR) experience preferred
Current AHA BLS (Heartsaver) certification required
Strong computer proficiency, including Microsoft Office and electronic health records
Excellent organizational and time management skills
Strong attention to detail and accuracy
Outstanding customer service and communication skills
Ability to manage multiple priorities in a fast-paced environment
Critical thinking and problem-solving abilities
Ability to work independently while collaborating effectively with providers and clinical staff
Experience with Cerner or other electronic health records preferred

Nice To Haves

The ideal candidate: Enjoys helping patients navigate the healthcare system
Thrives in a fast-paced, detail-oriented environment
Is highly organized and proactive
Builds positive relationships with patients, providers, and community partners
Demonstrates professionalism, compassion, and accountability
Embodies PSMC's WISER values of Wholeness, Integrity, Stewardship, Excellence, and Respect

Responsibilities

Process referrals from primary care and specialty providers using the electronic health record and referral management platform
Verify patient demographics, insurance information, and referral requirements
Compile and transmit clinical documentation, laboratory results, imaging, and other required records to receiving providers
Monitor referral status from initiation through completion
Follow up on outstanding referrals to ensure timely patient care
Document all referral activity accurately within the electronic health record and referral management system
Verify insurance coverage and referral requirements
Obtain prior authorizations for services when required
Monitor authorization expiration dates and obtain renewals as appropriate
Ensure all required testing and documentation are completed prior to referral processing
Maintain knowledge of referral requirements for commonly utilized specialty providers
Communicate referral status with patients, providers, nursing staff, and specialty offices
Respond to patient phone calls, voicemail messages, and patient portal communications in a timely manner
Assist patients with questions regarding the referral process
Communicate changes in referral requirements to clinic staff
Coordinate care with the VA and other external organizations as appropriate
Collaborate with providers and clinic leadership to ensure continuity of care
Manage referral worklists and patient population lists
Assist with patient outreach, scheduling, and coordination activities
Monitor incoming referral faxes and electronic referrals
Support quality initiatives and population health activities
Utilize electronic fax systems and electronic health records efficiently
Scan and upload documents into patient records
Maintain accurate documentation using approved workflows and abbreviations
Assist providers and clinic staff with referral-related questions and processes
Participate in departmental training, quality improvement initiatives, and ongoing professional development