Referral Specialist

HEALTH CARE PARTNERS; Conway (SC); On-site; USD 42,000 - 54,000; Full time

Job summary

HEALTH CARE PARTNERS is seeking a Referral Specialist to coordinate patient referrals to specialty providers and ancillary services, ensuring timely access to medically necessary care. The role works closely with providers, patients, specialists, hospitals, and insurers to obtain referrals, authorizations, and appointments while maintaining HIPAA compliance and accurate documentation in the EHR.

Strong organizational and communication skills are essential.

Qualifications

• High school diploma or equivalent required.
• Certified Medical Assistant (CMA or CCMA) certification preferred but not required.
• Minimum of two years of experience in referral coordination or related healthcare settings preferred.
• Experience obtaining prior authorizations, insurance verification, or coordinating referrals preferred.
• Experience working in a Federally Qualified Health Center (FQHC) or community health center preferred.
• Experience using Electronic Health Record (EHR) systems preferred.

Responsibilities

• Coordinate and process referrals to specialists, diagnostic testing, and ancillary services in accordance with HCPSC policies and provider orders.
• Obtain prior authorizations and insurance approvals required for specialty services, procedures, and diagnostic testing.
• Schedule referral appointments and communicate appointment details, preparation instructions, and follow-up information to patients.
• Collaborate with providers, specialists, hospitals, and insurance companies to facilitate timely referral processing and continuity of care.
• Track referral status to ensure appointments are completed and consultation reports are received and incorporated into the patient’s Electronic Health Record (EHR).
• Verify and update patient demographic, insurance, and referral information to ensure accurate processing.
• Maintain accurate documentation of referrals, authorizations, communications, and patient follow-up activities within the Electronic Health Record (EHR).
• Respond to patient questions regarding referrals, authorizations, and specialty appointments while providing excellent customer service.
• Assist with resolving referral, insurance, and billing issues related to specialty care.
• Maintain patient confidentiality and protect health information in accordance with HIPAA and organizational policies.
• Participate in required trainings, staff meetings, and quality improvement initiatives.
• Perform other duties as assigned.

Skills

Referral coordination

Prior authorization

Insurance verification

Customer service

Organizational skills

Communication skills

EHR proficiency

HIPAA compliance

Education

High school diploma

CMA/CCMA certification (preferred)

Tools

Microsoft Office

EHR systems

Job description

Position Summary

TheReferral Specialist coordinates patient referrals to specialty providers andancillary services to ensure timely access to medically necessary care. Thisposition works closely with providers, patients, specialists, hospitals, andinsurance companies to obtain referrals, authorizations, and appointments whilepromoting continuity of care. The Referral Specialist serves as a resource forpatients throughout the referral process and helps ensure referrals arecompleted accurately and efficiently.

Essential Duties and Responsibilities

• Coordinate and process referrals to specialists,diagnostic testing, and ancillary services in accordance with HCPSC policiesand provider orders.
• Obtain prior authorizations and insuranceapprovals required for specialty services, procedures, and diagnostic testing.
• Schedule referral appointments and communicateappointment details, preparation instructions, and follow-up information topatients.
• Collaborate with providers, specialists,hospitals, and insurance companies to facilitate timely referral processing andcontinuity of care.
• Track referral status to ensure appointments arecompleted and consultation reports are received and incorporated into thepatient’s Electronic Health Record (EHR).
• Verify and update patient demographic,insurance, and referral information to ensure accurate processing.
• Maintain accurate documentation of referrals,authorizations, communications, and patient follow-up activities within theElectronic Health Record (EHR).
• Respond to patient questions regardingreferrals, authorizations, and specialty appointments while providing excellentcustomer service.
• Assist with resolving referral, insurance, andbilling issues related to specialty care.
• Maintain patient confidentiality and protecthealth information in accordance with HIPAA and organizational policies.
• Participate in required trainings, staffmeetings, and quality improvement initiatives.
• Perform other duties as assigned.

Education & Experience

• High school diploma or equivalent required.
• Certified Medical Assistant (CMA or CCMA)certification preferred but not required.
• Minimum of two (2) years of experience inreferral coordination, medical office operations, patient access, carecoordination, or a related healthcare setting preferred.
• Experience obtaining prior authorizations,insurance verification, or coordinating specialty referrals preferred.
• Experience working in a Federally QualifiedHealth Center (FQHC) or community health center preferred.
• Experience using Electronic Health Record (EHR)systems preferred.

Knowledge, Skills, and Abilities

• Knowledge of referral coordination, priorauthorization processes, insurance verification, and medical terminology.
• Knowledge of HIPAA regulations and the abilityto maintain the confidentiality, security, and integrity of patientinformation.
• Strong organizational, communication, andcustomer service skills with the ability to manage multiple priorities in a fast-paced healthcare environment.
• Proficiency in Microsoft Office and ElectronicHealthRecord (EHR) systems.
• Ability to collaborate effectively withproviders, specialists, hospitals, insurance companies, and interdisciplinaryhealthcare teams.
• Ability to exercise sound judgment, solveproblems effectively, and maintain accurate documentation.