Referral Specialist
Summary
Coordinates patient referrals, verifies insurance, and manages prior authorizations in a community health center using medical records and payer systems.
- Track and follow up on prior authorization requests after submission, including communication with payers, providers, pharmacies, and patients as needed.
- Coordinate and monitor referrals for diagnostic testing, specialist visits, laboratory orders and results, and ancillary services such as physical therapy, home health care, and durable medical equipment.
- Contact outside facilities, physician offices, and specialty providers to obtain clinical results, visit summaries, consultation notes, and other required documentation.
- Provide or obtain additional clinical information needed to support referral and authorization requests.
- Follow up with patients to support compliance with provider orders and assist with scheduling diagnostics, labs, specialist appointments, or pharmacy-related needs.
- Help close the referral loop by tracking pending referrals, obtaining results or reports, updating the care team, and ensuring documentation is complete in the electronic medical record.
- Communicate professionally with patients, providers, insurance representatives, pharmacies, and external healthcare organizations to resolve delays or barriers to care.
- Maintain accurate, timely, and confidential documentation of referral and authorization activity in accordance with organizational policies and applicable privacy standards.
- Collaborate with clinical and administrative team members to stabilize workflow between prior authorizations, patient referrals, and provider follow-up.
- Perform other related duties as assigned to support patient care coordination and clinic operations.