Referral and Compliance Specialist

Walden Community Services

Exempt/Salary

12-Month

Full-time

Hourly Pay Range: $53,040.00 - $63,440.00

In-Person

American Sign Language Required

$1,500 Sign-on Bonus

Housing Resources Available

Tuition Reimbursement

Benefits Options May Include: Health, Dental, Vision, Life Insurance, Employer-Matching 403(b), Generous Time Off Benefits, Flexible Spending and Dependent Care, and more!

About TLC:

The Learning Center for the Deaf is a nationally-recognized leader of services for deaf and hard of hearing children, adults and families. To learn more, click the following link, https://www.tlcdeaf.org/about/pioneer-and-innovator.

For our Mission, click the following link, https://www.tlcdeaf.org/our-mission-and-values.

TLC Diversity Statement:

The Learning Center for the Deaf is on a journey to create an inclusive and welcoming space for people of all backgrounds. Together, we continue to build an inclusive culture that encourages, supports, and celebrates our TLC community members' diverse narratives. We embrace and value multiple approaches, experiences, and perspectives. TLC believes that diversity fosters innovation. We are committed to cultivating a place where everyone can feel they belong.

About Walden Community Services:

WCS offers intensive care coordination, wraparound family support and in-home therapy and stabilization for deaf and hard of hearing children, adults, and their families across Massachusetts.

POSITION SUMMARY:

The Referral & Compliance Specialist serves as the primary point of entry (“front door”) for individuals and families seeking outpatient or community-based behavioral health services. This role is responsible for managing referral flow, coordinating intake processes, and ensuring access to care.

The Specialist acts as a key liaison between patients, families, providers, referral sources, and interdisciplinary teams to promote continuity, safety, and service engagement.

SUPERVISOR: Director Walden Community Services

FUNCTIONS AND RESPONSIBILITIES:

Intake and Patient Access

• Serve as the initial point of contact for new referrals, patients, families, and community partners.
• Conduct intake screenings to gather demographic, clinical background, and presenting needs.
• Explain program services, referral expectations, and next steps in a clear, supportive manner.
• Determine urgency of need and coordinate appropriate scheduling or escalation when required.

Referral Coordination, Reporting, and Care Navigation

• Oversee and track all referrals from receipt through completion, ensuring timely follow-through.
• Maintain referral and waitlist systems using electronic databases and tracking tools.
• Act as a system navigator and advocate to reduce barriers to care (e.g., interpreters, transportation, financial supports).Ensure referral information is communicated accurately to clinicians, providers, and interdisciplinary teams.
• Complete required weekly, monthly, and quarterly state and contract reporting related to referrals, waitlists, service access, and discharge activity.
• Enter, track, and reconcile data across platforms including MABHA, CSA Connector, and other state-designated systems.

Insurance Verification and Authorization Compliance

• Collect and verify insurance eligibility, benefits, and referral requirements.
• Obtain prior authorizations and approvals in coordination with payers and managed care entities.
• Present required clinical information to support authorization decisions.
• Support accurate billing processes through complete insurance and registration documentation.
• Respond to client questions related to insurance coverage, denials, and financial responsibility.

Documentation and Record Management

• Maintain accurate and up-to-date clinical and referral documentation in the Electronic Health Record (EHR).
• Track and document referral status to promote team awareness and patient safety.
• Ensure confidentiality and compliance with HIPAA and clinical documentation standards.

Communication, Customer Service, and Team Support

• Communicate professionally with patients, families, providers, referral sources, and insurers via phone, email, fax, chat, and mail.
• Provide exceptional, accurate insurance and authorization compliance, maintaining complete documentation in the electronic health record, and supporting timely culturally responsive customer service with empathy and respect.
• Collaborate closely with billing departments, clinicians, supervisors, and program leadership.
• Support complaint resolution and follow crisis communication protocols when needed.
• Support onboarding with new staff by ensuring staff are in compliance with insurance (setting NPI, profiles, etc).
• Perform additional administrative and program support duties as assigned.

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities, and activities may change or new ones may be assigned at any time with or without notice.

The Learning Center for the Deaf provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religious creed, national origin, sex, pregnancy, gender identity/expression, age, criminal record, disability, sexual orientation, familial status, veteran status, marital status and any other legally protected characteristic.

• Masters Degree in clinical work such as social work or mental health counseling or 3 years equivalent experience 
• Ability to maintain confidentiality 
• Comfortable contacting clients by cold calling and informing them of referrals
• Bicultural competency and effective interpersonal and communication skills will be necessary to work collaboratively with the team
• Competent in using relay services 
• Ability to work well independently and as part of a team
• Microsoft Office skills and ability to work with Mac/Apple computers  
• Excellent attention to details 
• Ability to maintain organized records 
• A minimum of conversational fluency in American Sign Language required, with native, or near-native ASL fluency preferred
• ASL Classes may be required based on ASL fluency