Clinical Referral Specialist Outgoing

Position Summary:

The Outgoing Clinical Referral Specialist is responsible for coordinating all referrals initiated by internal providers to outside specialists and services. This includes reviewing the clinical intent, processing referral authorizations, and ensuring that patients are referred to appropriate in-network providers. The specialist plays a critical role in maintaining continuity of care and ensuring that referral workflows comply with payer guidelines.

Key Responsibilities:

• Monitor the EMR and telephone encounters for internal provider-generated referrals.
• Review clinical documentation to ensure appropriate justification and completeness before processing referrals.
• Assign referrals to appropriate specialists based on insurance network status, patient preference, and provider recommendation.
• Submit referral authorization requests to insurance companies when required.
• Coordinate delivery of clinical notes, imaging, and any supporting documentation to the receiving specialist.
• Track referral status and follow up to confirm patient appointment scheduling with external offices.
• Manage communications between patients, providers, and external specialists to support continuity of care.
• Ensure timely documentation of all referral activities in the EMR system.
• Support special referrals such as DME, home health, sleep studies, and physical therapy requiring payer authorization or physician follow-up.
• Identify and escalate urgent or complex referrals to clinical leadership as necessary.