Referrals Specialist

    • Job Tracking ID: 2021-909
    • Job Location: Rohnert Park, CA
    • Job Level: Entry Level (less than 2 years)
    • Level of Education: High School/GED
    • Job Type: Full-Time/Regular
    • Date Updated: September 17, 2021
    • Years of Experience: Up to 2 Years
    • Starting Date: ASAP
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Job Description:

Summary: Entry level position responsible for providing excellent patient care and customer service by ensuring that a patient's insurance allows them to access specialty services via coordination, processing, and completing of all internal and external specialty clinic referrals authorizations within expected timeframe.

Areas of Responsibility:


Patient Care

· Verification of patient insurance eligibility.

· Maintains updated authorizations/referrals information in patient chart through a tracking mechanism.

· Provides assistance to uninsured patients to be enrolled in PAP program.

· Provides information to patient through warm hand offs as needed.


Customer Service

· Makes and/or answers phone calls regarding any referral questions.

· Assist patients in the appeals process for denial of services through the proper appeals process with their insurance companies.

· Maintain extensive resource directory for PHC staff and patients for access of community resources.


Referral Tracking

· Process all outside referrals from other PCP/specialist within expected timeframe.

· Closes 20 referrals daily.

· Tracks the completion of the referral process within expected timeframe.

· Track referrals by using structured data to maintain up to date accurate information.

· Ensures follow up with Public Health Nurse for CHDP Referrals made.

· Knowledge of managed care requirements for referrals.

· Participates in MAA Coordination and Claims Administration, including but not limited to completion of the annual time survey.

· Perform other duties as assigned by Referrals and Specialty Clinics Operations Manager or Director of Clinical Operations

Experience and Skills:

Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


New employees are mandated to either provide proof of their COVID vaccination or to receive the vaccine, either through PHC or their own provider, with the first dose of a series required before the first day of employment. Exception to this mandate will be considered for those with a medical or religious exemption.

· Ability to effectively present information and respond to questions from groups of patients, physicians and other medical personnel concerning referral resources for various payers.

· Excellent organizational skills with attention to detail, multi-tasking and the ability to prioritize tasks and needs of patients and providers.

· Ability to communicate, both written and verbal.




· High school graduate with medical office training.

· Two years experience with insurance, referrals, authorizations, and community contacts.



Other Desired Skills:


· An energetic and creative individual with high standards and an appropriate professional image.

· Proven ability to handle multiple projects and meet deadlines.

· Versatility, flexibility and willingness to work within an ambiguous, fast-paced environment.

· Demonstrated resourcefulness in providing solutions and setting priorities.

· Effective interpersonal skills to work effectively with all levels within the health center.


Licenses and Certifications: None


Language Skills: Ability to communicate effectively in English and Spanish with children and adults in person, on the telephone, and in writing. Ability to effectively present information and respond to questions and requests from patients, co-workers and others as necessary.


Mathematical Skills: Ability to add, subtract, multiply, divide in all units of measure, using whole numbers, common fractions and decimals.


Reasoning Ability: Ability to recognize problems, collect data, and establish facts.


Computer Skills: Computer literate and proficient in MS Office (Word, Excel and Outlook), electronic medical records and web applications. This position requires a High level of computer literacy, ability to type at least 50 wpm


Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable

accommodations may be made to enable individuals with disabilities to perform the essential functions.


· Movement within health center complex environment repeatedly throughout the day.

· Ability to write by hand, use phone, use computer keyboard and mouse extensively to perform general office functions.

· Manual and finger dexterity and wrist-finger speed sufficient to perform repetitive actions for extended periods of time.

· Ability to effectively communicate by hearing continuously and speech in a manner which can be understood by a diverse population.

· Ability to give and follow verbal and written instructions with attention to detail and accuracy.

· Must have visual acuity near and far (20 inches to 20 feet), depth perception, field of vision, ability to focus on an object, ability to identify and distinguish colors.

· Ability to sit or stand for minimum period of one (1) hour.

· Ability to frequently walk, bend, squat, stoop, kneel, twist, crouch, and climb with the use of a step stool.

· Ability to grasp, hold and pick up and reach with hands and arms.

· Ability to frequently lift and or move up to fifteen (15) pounds.

· Ability to occasionally lift and carry up to thirty-five (35) pounds (periodic lifting of supplies or equipment).

· Ability to coordinate multiple tasks simultaneously.


Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


While performing the duties of this job, the employee is regularly exposed to Health Center areas and general office environment. The work environment is a clean, well-lit, well-ventilated, and temperature controlled environment. The noise level in the work environment is usually moderate. The hours of duty are lengthy and irregular.


Acknowledgment: This job description in no way states or implies that these are the only duties to be performed by the employee incumbent in this position. The Employee may be required to follow any other job-related instructions and to perform any other job-related duties requested. This document does not create an employment contract, implied or otherwise, other than an "at-will" relationship.