Referral Specialist

Department: Rural Health Clinic
Status: Part-Time | 0.5 FTE (20 hours/week)
FLSA Status: Non-Exempt
Reports To: Manager: Clinic
Location: Pagosa Springs Medical Center – Pagosa Springs, Colorado (Remote/hybrid may be considered based on departmental needs.)

🏥 Position Highlight

Help ensure patients receive timely access to specialty care by coordinating referrals, insurance authorizations, and communication between providers, patients, and specialty clinics.

Position Summary

Pagosa Springs Medical Center (PSMC) is seeking a detail-oriented and patient-focused Referral Specialist to join our Rural Health Clinic team.

The Referral Specialist serves as a vital link between patients, primary care providers, specialty providers, and insurance carriers. This role is responsible for processing referrals, verifying patient and insurance information, coordinating required documentation, obtaining authorizations when needed, and tracking referrals from initiation through completion. The Referral Specialist helps ensure patients experience a seamless transition of care while maintaining accurate documentation within the electronic health record.

Why Join PSMC?

• Make a meaningful impact by helping patients access the specialty care they need
• Work closely with providers, nursing staff, and specialty offices
• Be part of a collaborative team committed to outstanding patient care
• Develop expertise in referral coordination, insurance authorization, and care management
• Enjoy a flexible part-time opportunity within a supportive rural healthcare organization

Key Responsibilities

Referral Coordination

• Process referrals from primary care and specialty providers using the electronic health record and referral management platform
• Verify patient demographics, insurance information, and referral requirements
• Compile and transmit clinical documentation, laboratory results, imaging, and other required records to receiving providers
• Monitor referral status from initiation through completion
• Follow up on outstanding referrals to ensure timely patient care
• Document all referral activity accurately within the electronic health record and referral management system

Insurance & Authorization

• Verify insurance coverage and referral requirements
• Obtain prior authorizations for services when required
• Monitor authorization expiration dates and obtain renewals as appropriate
• Ensure all required testing and documentation are completed prior to referral processing
• Maintain knowledge of referral requirements for commonly utilized specialty providers

Patient & Provider Communication

• Communicate referral status with patients, providers, nursing staff, and specialty offices
• Respond to patient phone calls, voicemail messages, and patient portal communications in a timely manner
• Assist patients with questions regarding the referral process
• Communicate changes in referral requirements to clinic staff
• Coordinate care with the VA and other external organizations as appropriate

Care Coordination

• Collaborate with providers and clinic leadership to ensure continuity of care
• Manage referral worklists and patient population lists
• Assist with patient outreach, scheduling, and coordination activities
• Monitor incoming referral faxes and electronic referrals
• Support quality initiatives and population health activities

Administrative Support

• Utilize electronic fax systems and electronic health records efficiently
• Scan and upload documents into patient records
• Maintain accurate documentation using approved workflows and abbreviations
• Assist providers and clinic staff with referral-related questions and processes
• Participate in departmental training, quality improvement initiatives, and ongoing professional development