Specialty Referral Specialist

Central Florida Health Care•Winter Haven, FL

About The Position

The Specialty Referral Specialist manages outgoing and incoming specialty referrals from initiation through completion, including referrals to CFHC specialty providers. The role serves as a liaison among patients, providers, and specialty offices to support accurate, timely referral processing and continuity of care. Duties include reviewing provider orders; initiating referrals; gathering and verifying third-party information; checking insurance coverage and authorization requirements; submitting and following up on prior authorization requests; and coordinating or scheduling referral appointments. The specialist communicates referral status to patients and providers, follows up on pending referrals, and works with case managers, providers, and specialists to expedite urgent referrals. The position maintains accurate documentation of referral communications, authorization requirements, and outcomes in the electronic medical record (EMR), tracks referral completion and patient follow-up, and responds to referral-related inquiries. All work must comply with HIPAA requirements and protect the confidentiality of patient records.

Requirements

High school graduate or GED.
Minimum 1–2 years of experience in a medical office, referral coordination, or healthcare administration.
Familiarity with insurance processes, prior authorization, and medical terminology.
Proficiency with 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 and insurance programs, such as Medicaid.
Strong customer service focus.
Ability to manage competing priorities, solve problems resourcefully, and follow through on delegated tasks.
Ability to work as part of a team.
Ability to perform essential job-specific functions unaided or with a reasonable accommodation.

Nice To Haves

Certified Medical Assistant or Registered Medical Assistant.

Responsibilities

Coordinate all aspects of completing referrals ordered by CFHC providers.
Complete referrals within the stated timeframes: STAT referrals by the end of the business day, URGENT referrals within 24 hours, and ROUTINE referrals within 72 hours.
Obtain appropriate insurance authorizations and submit documentation from the patient’s medical record as required.
Schedule referral appointments when applicable and ensure appropriate paperwork is faxed to the specialist or provided to the patient.
Notify patients of scheduled referral appointments.
Document referral activities appropriately and thoroughly in the EMR.
Track referrals to support quality and continuity of care, including making reminder calls before appointments and obtaining reports from specialists.
Notify the ordering provider and/or Referral Specialist Supervisor about problems obtaining referrals, authorization or appointments, patient refusal, or patient no-shows.
Maintain the specialty provider list, including accepted payor sources.
Review the referral log weekly to ensure referrals are completed.
Follow CFHC philosophies, policies, procedures, and applicable state and federal regulations.
Report pertinent information or situations affecting patient care or CFHC liability to the CMO as needed.
Attend and participate in mandatory CFHC and other designated meetings.
Work cooperatively with clinical team members and support coworkers.
Maintain a neat and professional appearance.
Carry out other activities deemed appropriate by the CMO or CEO and other duties assigned by the Referral Specialist Supervisor.