Referral Specialist Jobs

About The Position

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.