Referral Specialist

About the role

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. This is a contract position based out of Goleta, CA, operating onsite in a team‑oriented, fast‑paced healthcare setting that relies heavily on EHR/EMR systems for documentation and communication, involving the management of a high volume of referrals each day.

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.

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.
• Experience in a healthcare or clinical environment supporting patient care coordination.
• Demonstrated ability to work collaboratively in a team-oriented environment.