Patient Access- Referral Specialist

JOB SUMMARY: The Patient Access Referral Specialist coordinates specialty referrals, prior authorizations, and access to external medical services and resources to support continuity of care. This role is a liaison between patients, internal providers, specialists, insurance payers and community partners. The Patient Access Referral Specialist provides services that meet established performance expectations while ensuring effective care coordination.

ESSENTIAL FUNCTIONS:

• Review referral requests for accuracy, completeness, and required supporting documentation.
• Verify insurance eligibility, referral requirements, and submit authorizations according to payor policies.
• Communicate referral status updates with patients, providers, specialty offices, and internal care teams.
• Schedule specialty appointments and assist patients in navigating external healthcare services.
• Collaborate with providers, clinical staff, insurance payers, and community partners to support continuity of care.
• Respond to patient, internal care team, and external partner inquiries regarding referrals and care coordination.
• Identify barriers to care and assist patients with accessing appropriate internal and/or external resources.
• Monitor referral work queues and follow up on pending referrals, authorizations, specialty appointments, and medical records.
• Provide services aligned with organizational standards to support the NNHOPES mission.
• Maintain effective communication and coordination between internal departments and external healthcare organizations.
• Uphold privacy and HIPAA laws by ensuring patient information is always confidential.
• Evaluate uninsured patients for assistance programs, insurance resources, and alternative care options to support access to medically necessary services.
• Maintain current knowledge of specialty providers, services offered, insurance participation, referral requirements, and patient acceptance status.
• Coordinate retrieval and transmission of medical records required to support referral processing and continuity of care.
• Document referral activities, authorizations, and communication in the electronic health record in accordance with organizational standards.
  
  

MINIMUM QUALIFICATIONS:

• High School Diploma, GED, or equivalent work experience required.
• 12 years of experience with medical terminology, healthcare workflows, and referral coordination required.
• Ability to maintain confidentiality and comply with HIPAA and organizational policies required.
• Ability to work independently and collaboratively within a multidisciplinary healthcare team required.
• Ability to communicate effectively with patients, providers, specialist, insurance payers, and community partners required.
• Understanding of insurance eligibility, payer requirements, prior authorizations and referral guidelines preferred.
  
  

At HOPES, we’re more than just a healthcare provider — we’re a team of changemakers dedicated to delivering affordable, high-quality medical, behavioral health, and support services to everyone in our community.

Why Choose HOPES?

• PurposeDriven Work
  
  

Be part of a team that’s transforming lives every day. Your work will directly contribute to improving health outcomes and building a stronger, healthier Northern Nevada.

• PeopleFirst Culture
  
  

At HOPES, every team member is encouraged to bring their unique talents and perspectives to the table. Collaboration and innovation are at the heart of everything we do.

• Career Growth and Development
  
  

We invest in your future by offering a mentorship program, leadership and soft-skills training, networking opportunities, and support for continuing education.

• Exceptional Benefits
  
  

100% employer-paid health insurance Life insurance options 3 weeks of PTO in your first year 12 paid holidays annually Paid Parental Leave (after 12 months) 24/7 Employee Assistance Program Click HERE to view a full list of benefits

• Due to real and potential conflicts of interest that exist when HOPES Behavioral Health providers render services to their coworkers, it is HOPES’ policy (Policy HR0005) that HOPES employees may not access HOPES Behavioral Health Services. For the same reason, current Behavioral Health patients/clients cannot be employed by HOPES. Accordingly, you hereby acknowledge and understand that if you are receiving services from a HOPES Behavioral Health provider at the time you are offered and accept employment with HOPES, you have the option of rescinding your acceptance of employment or finding a new behavioral health provider outside of HOPES before starting employment with HOPES.