Position Summary:
Heartland Health Center (HHC) is a Federally Qualified Health Center (FQHC), which provides affordable and comprehensive primary healthcare and dental care to medically uninsured, under-insured, and low- income individuals and families in Grand Island and surrounding communities.
The Referral Specialist coordinates specialty referrals, prior authorizations, and external healthcare services to ensure patients receive timely access to medically necessary care. This position serves as the primary liaison between HHC, specialty providers, hospitals, diagnostic facilities, pharmacies, insurance carriers, and patients to facilitate seamless coordination of referrals and continuity of care.
Essential Duties and Responsibilities
· Coordinate referrals for specialty care, diagnostic testing, procedures, therapies, and other external healthcare services as directed by providers and other members of the patient care team.
· Assist with gathering necessary documentation and manage prior authorizations while ensuring timely submission and follow-up.
· Monitor referral status from initiation through completion.
· Communicate with outside organizations regarding referral process and authorization status.
· Coordinate the collection and exchange of outside medical records, consultation reports, and diagnostic results.
· Track referral completion, identify outstanding referrals, and follow up with patients and external providers as needed.
· Educate patients regarding referral processes, insurance requirements, and appointment expectations.
· Collaborate with providers, clinical staff, and patients to resolve referral barriers and improve access to specialty care.
· Maintain accurate documentation within the electronic health record and referral management systems.
· Monitor referral metrics, authorization trends, and process improvement opportunities.
· Ensure compliance with payer requirements, organizational policies, HIPAA, and regulatory standards.
· Participate in workflow improvement initiatives to enhance referral efficiency and patient access.
· Assists Medical Records to maintain and manage accurate and up-to-date patient medical records, ensuring compliance with regulatory standards and facilitating smooth access to information.
· Empowers the patient to problem-solve by exploring options of care, when available, and alternative plans, when necessary, to achieve desired outcomes. Encourage the appropriate use of health care services and strives to improve quality of care and maintain cost effectiveness on a case-by-case basis
· Records patient progress including charting referrals and other notable interactions
· Demonstrates excellent written, verbal, and listening communication skills, positive relationship building skills, and critical analysis skills.
· Demonstrates ability to work autonomously and be directly accountable for practice.
· Demonstrates leadership qualities including time management, verbal and written communication skills, listening skills, problem solving, critical thinking, analysis skills and decision-making, priority setting, work delegation, and work organization.
· Demonstrates ability to develop collaborative relationships with patients, providers, specialists, and insurance representatives and set appropriate boundaries with patients/families.
Education and Experience
· High school diploma or GED
· 1+ years of experience in healthcare referrals, prior authorizations, or related healthcare experience preferred.
· Bi-lingual in English and Spanish preferred.
· Knowledge of referral management, prior authorization processes, insurance requirements, and healthcare terminology.
· Proficiency with Electronic Health Records (EHR), Microsoft Office applications, and referral management systems.
· Ability to manage multiple priorities while maintaining accuracy and attention to detail.
· Knowledge of HIPAA and applicable healthcare regulations.
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
