Specialty Referral Specialist

Central Florida Health Care•Winter Haven, FL

1d•Onsite

About The Position

The Specialty Referral Coordinator is responsible for processing, tracking, and coordinating all outgoing and incoming specialty referrals ordered by or referred to CFHC providers, acquiring and verifying third party information for referrals, obtaining referral appointments, and tracking referrals. This role ensures that referrals are handled efficiently, accurately, and in a timely manner while maintaining excellent communication between providers, patients, and specialty offices. The coordinator acts as a liaison to facilitate continuity of care and is responsible for the following: Reviewing provider orders and initiate specialty referrals, verifying insurance coverage and authorization requirements for referred services, submit prior authorizations as needed and follow up with insurance companies, communicate with patients regarding referral status ,ensure timely follow-up on pending referrals and update electronic medical records (EMR) ,maintain accurate documentation of all referral communications and outcomes coordinate with case managers, providers, and specialists to expedite urgent referrals, track and report referral completion and patient follow-up data ,ensure HIPAA compliance and confidentiality of patient records and respond to inquiries from patients and providers regarding the status of referrals.

Requirements

Certified and Registered Medical Assistants preferred
High School graduate or GED required
Minimum 1–2 years of experience in a medical office, referral coordination, or healthcare administration.
Familiarity with insurance processes, prior authorization, and medical terminology.
Proficient in EMR systems and Microsoft Office Suite.
Strong organizational skills and attention to detail.
Excellent interpersonal and communication skills.
Ability to multitask and work in a fast-paced environment.
Knowledge of basic medical terminology
Knowledge of various insurance programs (example, Medicaid)
Strong customer service focus
Effective verbal and written communication skills
Organized and able to manage competing priorities
Resourcefulness in problem solving
Able to take and follow through with delegated tasks
Team oriented

Responsibilities

Reviewing provider orders and initiate specialty referrals
Verifying insurance coverage and authorization requirements for referred services
Submit prior authorizations as needed and follow up with insurance companies
Communicate with patients regarding referral status
Ensure timely follow-up on pending referrals and update electronic medical records (EMR)
Maintain accurate documentation of all referral communications and outcomes
Coordinate with case managers, providers, and specialists to expedite urgent referrals
Track and report referral completion and patient follow-up data
Ensure HIPAA compliance and confidentiality of patient records
Respond to inquiries from patients and providers regarding the status of referrals
Coordinate all aspects of completing referrals ordered by CFHC providers
Complete referrals in a timely manner; STAT referrals must be completed by end of business day, URGENT referrals within 24 hours, and ROUTINE referrals within 72 hours
Obtain appropriate authorizations from insurance companies sending necessary documentation from the patient’s medical record as required
Schedule referral appointments for patient (when applicable) ensuring proper paperwork is faxed to the specialist or given to the patient to take to the appointment (example, labs, x-ray reports, progress notes)
Notify patient of scheduled referral appointment
Document appropriately and thoroughly
Track all referrals accordingly to improve the quality and continuity of care provided to patients. This includes, but is not limited to, initiating reminder calls to patients prior to their scheduled appointment and obtaining the referral report from the specialist.
Notify the ordering provider and/or Referral Specialist Supervisor of any problems in obtaining a patient’s referral, including issues with obtaining authorizations from third party payors or making appointments with a specialist, patient refusal of a referral, or patient no show to scheduled referral appointment
Maintain specialty provider list including payor sources they accept
Review referral log weekly to ensure completion of all referrals
Other duties as assigned by Referral Specialist Supervisor
Be familiar with CFHC’s program philosophies, goals and objectives.
Be cognizant of and comply with all CFHC’s policies and procedures, as well as state and federal regulations.
Be competent in performing the duties of a referral specialist.
Report as needed to CMO any pertinent information or situations that impact on patient care or CFHC liability.
Attend and participate in mandatory CFHC meetings (Center Specific meetings, corporate meetings, and other meetings as designated by the CMO or CEO).
Demonstrate ability to work cooperatively with other members of the clinical team.
Be supportive of coworkers.
Maintain a neat and professional appearance at all times.
Carry out any other activities deemed appropriate by the CMO or CEO.