Referral Specialist I

CommonSpirit Health; Novato (CA); On-site; USD 52,000 - 68,000; Full time

Job summary

Dignity Health's Pacific Central Coast Health Centers (PHC) is seeking a Referral Specialist to orchestrate patient access by managing referrals and authorizations. Responsibilities include obtaining clearances, issuing referrals for ancillary services, and coordinating with clinics to secure approvals for medications and services.

You will work with physicians, patients, and payers to process referrals, communicate plan details, schedule visits, and ensure timely handling based on urgency.

Qualifications

• High School Diploma or GED is required.

Responsibilities

• Gather, verify, and process referrals, authorizations, and pre-certifications by working closely with physician(s), patients and insurance payers.
• Communicate detailed information and answer patient questions regarding their health care plan; provide answers to billing and insurance clarification questions.
• Set up appointments, coordinate clinic visits, and any special arrangements such as transportation, interpreter services, specialty care, etc.
• Coordinate flow of information between medical clinic and referral authorization department to secure a valid referral for clinic patients.
• Enter referrals, documents, communications and action into the system, as appropriate.
• Prioritizes referrals by their urgency and addresses them in a timely manner.

Education

High School Diploma or GED

Job description

Job Summary and Responsibilities

As our Referral Specialist, you will orchestrate patient access to specialized care by expertly managing all referral and authorization processes.Every day, you will proactively obtain clearances for specialty visits, issue referrals for ancillary services (consults, imaging, labs), and secure approvals for medications, DME, home health, and other vital services.To be successful in this role, you will demonstrate meticulous attention to detail, strong organizational skills, and clear communication to ensure seamless and efficient service delivery for our patients.

• Gather, verify, and process referrals, authorizations, and pre-certifications by working closely with physician(s), patients and insurance payers.
• Communicate detailed information and answer patient questions regarding their health care plan; provide answers to billing and insurance clarification questions.
• Set up appointments, coordinate clinic visits, and any special arrangements such as transportation, interpreter services, specialty care, etc.
• Coordinate flow of information between medical clinic and referral authorization department to secure a valid referral for clinic patients.
• Enter referrals, documents, communications and action into the system, as appropriate.
• Prioritizes referrals by their urgency and addresses them in a timely manner.

Job Requirements

Required

• High School Graduate or GED

Where You’ll Work

Dignity Health's Pacific Central Coast Health Centers (PHC) is a non-profit Community clinic organization comprised of more than 40 health centers located primarily from Ventura to Templeton, spanning the coast. Our experienced physicians and advanced practice providers offer a wide range of primary and specialty care services. PHC is a part of Dignity Health Central Coast's award-winning network of outstanding hospitals, imaging centers, laboratories, and post-acute services.

One Community. One Mission. One California