Referral Specialist

Position Summary

The Referral Specialist is responsible for coordinating, processing, and scheduling specialty referrals and prior authorizations for a variety of medical services/procedures for patients as requested by the medical provider. As an integral member of the patient’s healthcare team, the Referral Specialist will collaborate with medical providers, nursing staff, and other patient care support staff to ensure patients receive specialty services timely and efficiently.

Essential Duties

• Schedules, problem-solves, communicates, and coordinates referral appointments with outside specialists.


• Tracks and enters all referral requests in the EHR daily.


• Coordinates with the Health Information Management staff to track the status of all provider reports on patients referred to hospitals, outside clinics, and Specialty Providers and follow up for reports/records not received on referred patients.


• Maintains an accurate record of external referral patient appointments that are kept or failed and updates status in the EHR and/or Excel spreadsheet.


• Answers, responds, and documents phone calls, requests, and questions from patients promptly.


• Utilizes third-party payer/insurance portals; understands insurance and their expectations for authorization approvals.


• Ensures proper use of CPT and current ICD-10 codes to meet the requirements of third-party payers and specialty clinics to ensure minimal delay in securing referral appointments or pre-authorizations. 


• Utilizes electronic health record functions to document all pertinent information.


• May perform referral tracking process utilizing the EHR.


• Identifies and utilizes cultural and community resources. 


• Establishes and maintains relationships with identified service providers.


• Maintains TMAA hours and submits accordingly.


• Other duties as assigned.

Additional Responsibilities

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  Follows and adheres to the Employee Handbook and MMHC policies and procedures.


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  Adheres to MMHC confidentiality policy and HIPAA laws.

Education and Skills

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  Minimum of a High School Diploma or equivalent


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  At least one year of relevant experience


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  Strong customer service skills


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  Effective verbal and written communication skills


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  Teamwork oriented


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  Organized and able to manage competing priorities, strong multi-tasking skills.


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  Ability to work collaboratively with leadership, providers, and staff.


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  Demonstrate professionalism in conduct, attire, and appearance.
  

Physical requirements

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  Bending, stooping, twisting, and reaching above and below the shoulder.


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  Handling/grasping documents or office equipment.


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  Sitting or standing for short or extended periods.


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  Clear speaking and adequate hearing are sufficient to communicate effectively and respond appropriately in person and on the telephone.


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  Vision sufficient to read source materials and computer screen data, with or without corrective lenses.


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  Repetitive motions for computer equipment use.

• Occasional lifting up to 25 pounds.

Working conditions

Work is performed primarily in an office environment using standard office equipment with moderate background noise. It is a daytime shift only, Monday through Friday. Most of the day is spent viewing a computer monitor. The work environment characteristics described here represent those an employee encounters while performing the job's essential duties. 

Reasonable accommodations will be given to qualified disabled applicants under Section 501 of the Rehabilitation Act of 1973,29 U.S. Code 791, Title 29, and the Americans with Disabilities Act (ADA).