Referral Specialist

Location: Buellton

Job Title:

Referral Specialist

Job Description

The Referral Specialist processes and coordinates internal and external referrals to specialty providers, ensuring timely and accurate completion of all referral-related activities. This role verifies insurance coverage, obtains prior authorizations, and maintains thorough documentation in the electronic health record system to support seamless patient care coordination. The Referral Specialist collaborates closely with clinical and administrative teams to manage high referral volumes in a fast-paced environment while providing clear communication to patients, providers, and specialty offices.

Responsibilities

+ Process and coordinate internal and external referrals to specialty providers in a timely and accurate manner.

+ Verify insurance coverage for patients and obtain prior authorizations as required by health plans and managed care organizations.

+ Submit referral requests to health plans, independent practice associations (IPAs), or specialty offices and track status updates through completion.

+ Ensure all supporting documentation, including chart notes, laboratory results, and imaging reports, is complete and attached to each referral.

+ Communicate referral status and any updates clearly and professionally to patients, providers, and specialty offices.

+ Maintain accurate and up-to-date documentation in the electronic health record (EHR) or electronic medical record (EMR) system for all referrals and authorizations.

+ Follow up on pending referrals to meet established turnaround times and ensure completion of the referral process.

+ Collaborate with front office staff, back office staff, and providers to support effective patient care coordination and resolve referral-related issues.

+ Manage a high volume of referrals daily while maintaining organization, accuracy, and adherence to referral workflows.

+ Apply medical terminology and knowledge of medical records to accurately interpret and process referral documentation.

Essential Skills

+ Previous experience in referrals, authorizations, or a medical office setting preferred.

+ Strong understanding of insurance types, including HMO, PPO, and Medi-Cal, and related referral workflows.

+ Experience working with EMR/EHR systems to enter, track, and update referral information.

+ Proficiency with medical terminology and medical record documentation.

+ Knowledge of prior authorization processes and managed care requirements.

+ Familiarity with Medicaid programs and guidelines.

+ Strong organizational skills with the ability to manage high referral volumes in a fast-paced environment.

+ Ability to handle multiple referrals daily while maintaining accuracy and attention to detail.

+ Effective communication skills to interact with patients, providers, and specialty offices.

+ Solid project coordination skills to track and follow through on all referral-related tasks.

Additional

Skills & Qualifications

+ Experience in a healthcare or clinical environment supporting patient care coordination.

+ Demonstrated ability to work collaboratively in a team-oriented environment.

+ Comfort with adapting to changing priorities and workflows as needed.

+ Motivation to grow within the organization and develop professionally.

Work Environment

This is a full-time position with a Monday through Friday schedule from 8:00 a.m. to 5:00 p.m. The role operates in a fast-paced healthcare setting that relies heavily on electronic health record (EHR) and electronic medical record (EMR) systems for documentation and communication. The environment is team oriented, with close collaboration among front office staff, back office staff, and providers to support coordinated patient care.

The position involves managing a high volume of referrals each day, requiring sustained focus, organization, and effective communication throughout the workday.

Job Type & Location

This is a Contract position based out of Buellton, CA.

Pay and Benefits

The pay range for this position is $23.00 - $26.00/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for…