Referral Representative III

St. John's Community Health; Los Angeles (CA); On-site; USD 45,000 - 75,000; Full time

Job summary

An established industry player is seeking a Referral Representative III to join their dedicated team. This role is pivotal in managing patient referrals and ensuring effective communication between patients and healthcare providers. The ideal candidate will possess strong customer service skills, attention to detail, and a commitment to patient care. With a focus on enhancing patient experiences, you will coordinate referrals, verify insurance, and navigate complex healthcare systems. This opportunity offers a supportive environment with extensive benefits, including medical, dental, and tuition reimbursement, making it an exciting prospect for those passionate about healthcare.

Benefits

Free Medical, Dental & Vision

13 Paid Holidays + PTO

403 (B) Retirement Match

Life Insurance

Tuition Reimbursement

Flexible Spending Account

Continued Workforce Development & Training

Succession Plans & Growth

Qualifications

• 3+ years in a healthcare call center or referral coordination role.
• Familiarity with insurance portals and medical terminology.
• Ability to handle sensitive patient information with confidentiality.

Responsibilities

• Handle inbound and outbound specialty referral calls from patients and providers.
• Coordinate appointments and consultations with healthcare providers.
• Document all patient interactions and ensure HIPAA compliance.

Skills

Customer Service

Attention to Detail

Interpersonal Communication

Data Collection

Bilingual English/Spanish

Adaptability

Education

High School Diploma

Associate’s Degree in Healthcare Administration

Tools

EHR Systems

Microsoft Office Suite

GO-TO Applications

Job description

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Join to apply for the Referral Representative III role at St. John's Community Health

Under the direction of the Referral Manager& Analyst, the Referral Representative III is responsible for handling inbound and outbound referral-related calls, coordinating patient referrals, verifying insurance, and ensuring seamless communication between patients, healthcare providers, and specialists. This role requires excellent customer service, a strong attention to detail, knowledge of healthcare referral processes, and a commitment to patient care.

Benefits

• Free Medical, Dental & Vision
• 13 Paid Holidays + PTO
• 403 (B) retirement match
• Life Insurance, EAP
• Tuition Reimbursement
• SEIU Union
• Flexible Spending Account
• Continued workforce development & training
• Succession plans & growth within
  
  

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education Requirements :

• High school diploma or associate’s degree or certification in healthcare administration, medical assistant or related field preferred.
  
  

Experience And Skills (Required)

• Minimum of 3+ years in a healthcare call center, or referral coordination role (preferred)
• Familiar with EHR systems, insurance portals, and GO-TO applications.
• Proficiency in data collection and reporting tools and dashboards.
• Strong interpersonal Communication (written and verbal)
• Technical Proficiency in Microsoft Office Suite, including Excel, Word, PowerPoint, Outlook
• Strong patient-centered approach with the ability to manage stressful situations.
• Ability to work efficiently in fast-paced environments while ensuring referral and customer service accuracy.
• Adaptability and creativity
• Detail Orientation
• Ability to handle sensitive patient information with confidentiality and professionalism.
• Knowledge of medical terminology, insurance procedures, referral processes, and healthcare services.
• Bilingual English/Spanish (required)
  
  

Essential Duties & Responsibilities

Performs a combination, but not necessarily all, of the following duties:

• Handle inbound and outbound specialty referral calls from patients, providers, and other healthcare professionals.
• Collect and verify patient information, medical history, and referral details.
• Coordinate appointments and consultations with appropriate healthcare providers and departments.
• Ensure accurate and timely processing of referrals in compliance with the organization's policies and procedures.
• Serve as the primary point of contact for escalated calls pertaining to external referrals and ensures concerns are addressed in a timely manner. Strive for a resolution that meets the patient's needs and resolves in a high-level satisfaction.
• Provide patients with information on referral procedures, healthcare services, and insurance coverage.
• Address patient inquiries and concerns with empathy and professionalism.
• Assist with scheduling external specialty appointments for complex patients as needed.
• Guide patients through the referral process, answering questions and addressing concerns
• Document all patient interactions, referral details, and follow-up actions in accordance with the organization's standards.
• Ensure confidentiality and security of patients’ information (HIPAA).
• Works closely with healthcare providers, medical staff, and administrative teams to facilitate efficient referral processes.
• Communicate effectively with internal departments to ensure coordinated patient care and seamless service delivery.
• Identify and resolve any issues or delays in the referral process promptly.
• Monitor daily call queues (LA & IE region/Referral Helpline) to ensure adequate staffing is equipped to answer high volumes of calls in a timely fashion.
• Run Go-To (App) report dashboards and Trends to improve efficiency.
• Monitors daily call activity for Referral Call Center and Referral Helpline.
• Assist Referral Administrative Auditor with Call Audits reports.
• Monitors monthly Referral Representative’s Saturday’s calendar work schedule and tracks attendance record.
• Stay updated on insurance policies, referral guidelines, and healthcare regulations.
• Meets with Referral Manager and Director of Referrals regularly or as needed.
• Assist with all functions (Processing, Scanning, Medical Records) as needed.
• Train staff Referral Representatives as needed.
• Back-up to train new onboarding providers.
• Performs other duties as assigned by the Referral Manager or Director of Referrals.
  
  

St. John's Community Health is an equal opportunity employer.

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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