REFERRAL CLERK

JOB SUMMARY:

The Referral Clerk/Referral Specialist is responsible for managing and coordinating patient referrals to ensure timely, accurate, and efficient access to specialty care services. This position provides focused oversight of the referral process from initiation through completion while maintaining excellent customer service and communication with patients, providers, and specialty offices.

The Referral Clerk/Referral Specialist demonstrates strong organizational and reporting skills, close attention to detail, timeliness, and the ability to work collaboratively within a fast-paced healthcare environment. This position supports efforts to improve continuity of care, reduce referral delays, and ensure compliance with organizational and payer requirements.

ESSENTIAL FUNCTIONS:

1. Processes and submits referrals in a timely and accurate manner.
2. Coordinates referrals and appointments with specialty providers and outside agencies.
3. Obtains prior authorizations and verifies insurance coverage for specialty services when required.
4. Ensures completeness and accuracy of referral documentation prior to submission.
5. Monitors referral status and ensures accurate and timely closure of referral loops.
6. Communicates with patients regarding referral scheduling, appointment details, and follow-up requirements.
7. Provides same-day referral notifications when applicable.
8. Maintains accurate and timely documentation within the electronic health record (EHR) system.
9. Supports providers and clinical teams with referral-related inquiries and updates.
10. Coordinates with internal departments and external specialty offices to facilitate continuity of care.
11. Tracks open referrals and assists with reducing referral backlogs and delays in patient care.
12. Ensures referrals are scheduled at the time of the patient visit whenever possible or before the patient leaves the clinic.
13. Maintains confidentiality of patient information in accordance with HIPAA guidelines.
14. Assists with reports, audits, and referral tracking activities as requested by management.
15. Performs other related duties as assigned by the supervisor or designee.

CUSTOMER SATISFACTION REQUIREMENTS:

Must provide excellent customer satisfaction to patients, visitors, vendors, and co-workers at all times in a professional and courteous manner. Must maintain a professional appearance and demonstrate effective communication and teamwork skills. Must actively assist in resolving patient concerns and promote a welcoming and patient-centered environment.

PERFORMANCE STANDARDS:

Performance will be evaluated annually by the Director of Customer Relations or designee wherein a satisfactory overall rating is considered a minimum acceptable level of performance.

PROTECTED HEALTH INFORMATION (PHI) ACCESS:

RESTRICTED – This position is classified under Ancillary Support Staff and therefore granted restricted access for the purpose of performing assigned job duties. Use and disclosure must be in accordance with applicable privacy policies and procedures.

HEALTH AND SAFETY REQUIREMENTS:

1. Must adhere to all safety regulations, personnel policies, and procedures.
2. Must complete annual Safety and Hazard Communication training.
3. Must comply with OSHA and HIPAA requirements.
4. Must maintain a clean, safe, and organized work environment.

PRIVACY RULE COMPLIANCE REQUIREMENTS:

1. Adheres to HIPAA Privacy Rule policies and procedures.
2. Completes Privacy Rule compliance training annually or as revisions are made to policies and procedures.
3. Protects patient confidentiality and medical privacy at all times.
4. Maintains patient information in compliance with national standards and organizational policies.

QUALIFICATIONS:

EDUCATION AND EXPERIENCE:

High school diploma or equivalent required. Previous healthcare, referral coordination, medical office, customer service, or insurance authorization experience preferred. Experience working within an FQHC or outpatient clinical setting preferred.

KNOWLEDGE, SKILLS, AND ABILITIES:

1. Knowledge of referral processes, insurance verification, and prior authorization procedures preferred.
2. Strong organizational, communication, and customer service skills.
3. Ability to prioritize tasks and work efficiently in a fast-paced environment.
4. Ability to maintain confidentiality and professionalism.
5. Proficiency in electronic health records (EHR) systems and general computer applications.
6. Ability to establish effective working relationships with patients, providers, specialty offices, and staff.
7. Ability to communicate effectively both verbally and in writing.

PHYSICAL/MENTAL DEMANDS:

Requires working under stressful conditions and maintaining attention to detail in a fast-paced healthcare environment. Must be able to sit, stand, bend, walk, and use office equipment for extended periods of time. Must be able to communicate clearly and effectively with patients, staff, and outside agencies.