Referral Specialist I

Commonspirit-Health; Santa Maria (CA); On-site; USD 42,000 - 55,000; Full time

Job summary

Commonspirit-Health is seeking a Referral Specialist to orchestrate patient access by managing referrals and authorizations for specialty visits, ancillary services, medications, and other vital care. The role requires detailed organization and clear communication to ensure smooth service delivery for patients in the Santa Maria area.

The position involves coordinating referrals with physicians, patients, and payers, scheduling appointments, and ensuring timely processing of all documentation in

Qualifications

• High School Diploma or GED required.

Responsibilities

• Gather, verify, and process referrals, authorizations, and pre-certifications by working closely with physicians, 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.

Skills

High School Diploma

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