Referral Representative

Family HealthCare Network; Fresno (CA); On-site; USD 52,000 - 62,000; Full time

Job summary

Family HealthCare Network is seeking a Referral Representative to assist patients with referrals, coordinate with insurers for pre-authorizations, verify eligibility, and schedule appointments with external and internal specialists.

The role uses the electronic health record system to document referral activity, generate packets, ensure timely processing, and communicate status to patients and providers.

Qualifications

• High school diploma or GED required, health care knowledge often gained through training.
• Minimum two years' experience in a health care setting.

Responsibilities

• Assist patients with referral completion across multiple service lines.
• Obtain pre-authorizations and verify patient eligibility.
• Coordinate and schedule appointments with specialists and communicate status.
• Ensure correct usage of CPT and ICD-10 codes for payers.
• Document referral processing activity in the EHR and report metrics.

Skills

Communication

Data entry

Customer service

Education

High school diploma or GED

Healthcare knowledge/training

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

Job description

Primary Accountability

The Referral Representative is responsible for assisting with patient referrals.

Description of Primary Responsibilities

1. Responsiblefor assisting patients with the completion of referrals including multiple service lines.
   1. Coordinates and communicates with various insurance carriers to obtain necessary pre-authorizations for patients to receive needed specialty services.
   2. Appropriately verifies patient eligibility to determine the best options for specialty access.
   3. Coordinates, communicates and schedules patient appointments with external and internal specialists and provides communication to the patients regarding the process and referral status.
   4. Ensures proper use of CPT and current ICD-10 codes to meet the requirements of third-party payers and specialty offices to ensure minimal delay in securing referral appointments or pre-authorizations.
   5. Prepares comprehensive referral packet, including referral order, pre-authorization paperwork, patient demographics, eligibility verification, primary care provider notes, diagnostics and/or lab work pertinent to the specialty referral.
   6. Submits required referral packet and documentation to the specialist to ensure timely processing of the referral.
   7. Ensures the efficient and timely processing of open referrals, including facilitating missing information, and that all referrals are appropriately closed and communicated to provider team.
   8. Addresses incoming calls and questions from patients and specialists regarding referral orders, care coordination and ensure the appropriate follow-up is completed.
   9. Coordinates surgeries with designated hospitals, specialists and patients. Obtains hospital pre-admission from the various health insurances and health plans.
   10. Responsible for submitting referral activity reports to supervisor.
2. Responsible for utilizing the electronic health record system to obtain and document necessary information.
   1. Monitors assigned worklist throughout the day to capture referral requests in real time and organize workload based on acuity.
   2. Documents all referral processing activity, including interactions with patients, providers and specialists.
   3. Utilizes third party payer/insurance portals appropriately to ensure adequate processing of referral orders.
   4. Follows-up on completion of the entire referralprocess, including closing referrals.
   5. Provides orientation on the referral process to new providers and periodic in-services to existing providers and staff regarding referral process.
   6. Assists with process analysis feedback to streamline internal referral processes.
   7. Achieves specific referral productivity metrics.
3. Responsible for adhering to the Attendance and Absenteeism Policy, recognizing that regular attendance is considered an essential function of all FHCN positions. Absenteeism is not being at work or failing to attend a paid workshop, training, or event unless the absence is protected by law.
4. Ability to present to and work at any FHCN location, both at the beginning of a shift or during a shift, based on business need.
5. Performs other duties as assigned.

Description of Primary Attributes

Professional & Technical Knowledge:

Effective June 1, 2026, all individuals hired into the role must:

1. Possesses work-related skills at a higher level than completion of high school, including formal written and verbal communications skills, computational and computer skills, mathematical, and technical skills.
   1. Must have proof of completion of high school with a minimum overall GPA of 2.5 or completion of General Educational Development (GED) with a minimum overall score of 162.5, and health care-related knowledge frequently acquired through completion of a trade school, para-professional, or certificate-type program.
   2. If an individual has completed a degree at a higher level than required by the role and had a stronger GPA in that program, they may provide proof of GPA from that degree in lieu of the high school diploma.
2. Have a minimum of two years of employment experience in a health care setting.

Technical Skills:

1. Ability to prepare more complex documents in Microsoft Word, including creating tables, charts, graphs and other elements.
2. Ability to use Microsoft Excel to review and compile data, including the use of formulas, functions, lookup tables and other standard spreadsheet elements.
3. Ability to create basic presentations in Microsoft PowerPoint.

Licenses & Certifications:Medical Assistant certification preferred.

Communications Skills:

1. Job duties require the compilation of information prepared in effective written form, including correspondence, reports, articles or other documentation.
2. Effectively conveys technical information to non-technical audiences.

Physical Demands: The physical demands described here in this job description are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this position, the employee is regularly required to sit and use repetitive hand movement to type and grasp. The employee is frequently required to stand or walk; and occasionally lift and/or move up to 20 pounds.

Pay Scale:

Min Hourly Rate: $25.00

Max Hourly Rate: $30.00