Specialty Referral Specialist

Central Florida Health Care; Winter Haven (FL); On-site; USD 25,000 - 33,000; Full time

Job summary

Central Florida Health Care, Inc. is seeking a Specialty Referral Specialist to manage the referral process from initiation through completion for all outgoing and inbound referrals.

You will act as a liaison among patients, providers, and specialty offices, ensuring referrals are processed accurately and promptly to support continuity of care. Responsibilities include reviewing orders, initiating referrals, verifying insurance and authorizations, submitting prior authorizations, and scheduling

Qualifications

• Certified and Registered Medical Assistants preferred; High School graduate or GED required.
• 1–2 years of experience in a medical office, referral coordination, or healthcare administration.
• Familiarity with insurance processes, prior authorization, and medical terminology.
• Proficient in EMR systems and Microsoft Office Suite.
• Strong organizational skills and attention to detail.
• Excellent interpersonal and communication skills.
• Ability to multitask and work in a fast-paced environment.

Responsibilities

• Manage the referral process from initiation to completion for all outgoing and incoming referrals.
• Review provider orders, initiate referrals, verify insurance and authorization requirements.
• Submit prior authorization requests as needed and coordinate with insurance companies.
• Schedule referral appointments and ensure proper paperwork is provided to patients and specialists.
• Maintain accurate documentation in the EMR and track referral outcomes.
• Communicate status to patients and providers and respond to inquiries.
• Ensure HIPAA compliance and protect patient confidentiality.

Skills

Communication skills

Organizational skills

EMR systems

Medical terminology

Multitasking

Education

High School diploma or GED

Certified Medical Assistant preferred

Tools

EMR software

Microsoft Office

Job description

Reports to: Referral Specialist Supervisor
FLSA Status: Non-Exempt
Personnel Supervised: None

POSITION SUMMARY:

The Specialty Referral Specialist manages the referral process from initiation through completion for all outgoing and incoming specialty referrals ordered by or referred to CFHC providers, including referrals to CFHC specialty providers. Serving as a liaison among patients, providers, and specialty offices, the specialist ensures referrals are processed accurately, efficiently, and promptly to support continuity of care. Responsibilities include reviewing provider orders, initiating referrals, acquiring and verifying third-party information, verifying insurance coverage and authorization requirements, submitting prior authorization requests as needed, following up with insurance companies, and coordinating and scheduling referral appointments.

The specialist communicates with patients and providers regarding referral status, follows up on pending referrals, and collaborates with case managers, providers, and specialists to expedite urgent referrals. This role maintains accurate, up-to-date documentation of referral communications, authorization requirements, and outcomes in the electronic medical record (EMR); tracks and reports referral completion and patient follow-up data; and responds to referral-related inquiries. All activities are performed in compliance with HIPAA requirements to protect the confidentiality of patient records.

MINIMAL QUALIFICATIONS:

• Certified and Registered Medical Assistants preferred High School graduate or GED required
• Minimum 1–2 years of experience in a medical office, referral coordination, or healthcare administration.
• Familiarity with insurance processes, prior authorization, and medical terminology.
• Proficient in EMR systems and Microsoft Office Suite.
• Strong organizational skills and attention to detail.
• Excellent interpersonal and communication skills.
• Ability to multitask and work in a fast-paced environment.

KNOWLEDGE AND SKILLS:

• Knowledge of basic medical terminology
• Knowledge of various insurance programs (example, Medicaid)
• Effective verbal and written communication skills
• Organized and able to manage competing priorities
• Resourcefulness in problem solving
• Able to take and follow through with delegated tasks
• Team oriented

RESPONSIBILTIES AND PERFORMANCE EXPECTATIONS include, but are not limited to, the following:

• Be familiar with CFHC’s program philosophies, goals and objectives. Be cognizant of and comply with all CFHC’s policies and procedures, as well as state and federal regulations.
• Be competent in performing the duties of a referral specialist.
• Report as needed to CMO any pertinent information or situations that impact on patient care or CFHC liability.
• Attend and participate in mandatory CFHC meetings (Center Specific meetings, corporate meetings, and other meetings as designated by the CMO or CEO).
• Demonstrate ability to work cooperatively with other members of the clinical team. Be supportive of coworkers.
• Maintain a neat and professional appearance at all times.
• Carry out any other activities deemed appropriate by the CMO or CEO.
• Coordinate all aspects of completing referrals ordered by CFHC providers
• Complete referrals in a timely manner; STAT referrals must be completed by end of business day, URGENT referrals within 24 hours, and ROUTINE referrals within 72 hours
• Obtain appropriate authorizations from insurance companies sending necessary documentation from the patient’s medical record as required
• Schedule referral appointments for patient (when applicable) ensuring proper paperwork is faxed to the specialist or given to the patient to take tothe appointment (example, labs, x-ray reports, progress notes)
• Notify patient of scheduled referral appointment
• Document appropriately and thoroughly
• Track all referrals accordingly to improve the quality and continuity of care provided to patients. This includes, but is not limited to, initiating reminder calls to patients priorto their scheduled appointment and obtaining the referral report from thespecialist.
• Notify the ordering provider and/or Referral Specialist Supervisor of any problems in obtaining a patient’s referral, including issues with obtaining authorizations from third party payors or making appointments with a specialist, patient refusal of a referral, or patient no show to scheduled referral appointment
• Maintain specialty provider list including payor sources they accept
• Review referral log weekly to ensure completion of all referrals
• Other duties as assigned by Referral Specialist Supervisor

PHYSICAL REQUIREMENTS

• Requires 80% or more time spent sedentary.
• Independently mobile.
• Ability to lift weight equivalents that would be required with repositioning equipment and lifting supplies.
• Ability to adapt and function in varying environments of workload, patient acuity, worksites, and work shifts.

American with Disabilities Act (ADA) Statement: External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job specific functions (listed within each job responsibility) either unaided or with the assistance of a reasonable accommodation to be determined by the organization on a case by case basis.