Referral Specialist

Department: Clinic

Position Type: Full-Time

FLSA: Non-Exempt

Reports To: Supervisor, Referrals

Job Summary

Join us and be a part of Trillium, a mission-driven team committed to expanding access to high-quality, compassionate care for everyone we serve.

Under the direction of the Supervisor, Referrals, the Referrals Specialist serves as a primary liaison between patients, providers, medical offices, healthcare facilities, and community agencies. This role coordinates outgoing referrals, specialty appointments, and radiology/imaging services by assisting patients through the referral process and advocating for timely access to care. The Referrals Specialist monitors referral completion, manages deferred referrals, obtains necessary documentation, and supports quality and compliance standards through accurate tracking and follow-up activities.

Duties/Responsibilities

Electronic Medical Record (EMR) Management - Epic

• Skilled in navigating patient charts and clinical documentation within Epic.
• Demonstrates an in-depth understanding of Epic workflows, workqueues, and user role configurations.
• Manages patient referrals and authorization processes through Epic.

Referral and Radiology/Imaging Coordination

• Utilizes Epic to assign patients to the appropriate provider or facility based on medical needs identified by Trillium Health providers.
• Verifies patient eligibility through insurance carrier portals and coordinates prior authorizations, precertifications, and referral authorizations as required.
• Electronically routes and faxes medical documentation through Epic to clinical staff, specialty providers, community agencies, and insurance payors.
• Utilizes Health Information Exchange (HIE) systems, including RHIO, to obtain medical reports and documentation related to referrals and imaging services.
• Obtains and reviews laboratory, radiology, surgical, and specialty-provider documentation to ensure continuity of care.
• Tracks referrals within Epic and verifies referral status with specialty providers and offices.
• Assists patients with scheduling specialty and imaging appointments when permitted.
• Conducts follow-up with patients who have missed referral or imaging appointments.
• Uses insurance carrier and utilization management portals to determine authorization requirements.
• Verifies patient insurance eligibility and coverage for services.

Medical Terminology and Documentation

• Demonstrates strong knowledge of medical terminology, abbreviations, and clinical language used throughout healthcare settings.
• Effectively applies medical terminology in referral management, insurance documentation, and EMR workflows to ensure accuracy and compliance.

HIPAA Compliance

• Adheres to HIPAA Privacy, Security, and Breach Notification Rules.
• Maintains compliance with minimum necessary standards when accessing Protected Health Information (PHI).
• Protects confidentiality and security of patient information.
• Completes all required HIPAA and confidentiality training.

Additional Responsibilities

• Supports Trillium Health's commitment to diversity, equity, inclusion, and belonging by treating all individuals with respect and dignity.
• Demonstrates and models One Trillium behaviors and business impacts.
• Maintains confidentiality of patient, client, employee, protected, and proprietary information.
• Participates in compliance audits, process improvement initiatives, and quality improvement activities.
• Contributes to continuous improvement of departmental and organizational processes.
• Performs other duties as assigned.

Required Skills/Abilities

• Excellent customer service and patient advocacy skills.
• Strong organizational, multitasking, and problem-solving abilities.
• Ability to work independently and collaboratively within a team environment.
• Knowledge of healthcare referral processes and community-based resources.
• Understanding of insurance carriers, prior authorization requirements, and sliding fee programs.
• Strong written and verbal communication skills.
• Proficiency with Microsoft Office Suite, including Word and Excel.
• Knowledge of HIPAA and confidentiality regulations.
• Bilingual language capabilities preferred.
• Experience using Epic Electronic Medical Records strongly preferred.

Education and Experience

• High School Diploma or equivalent required.
• Minimum of two (2) years of experience in a healthcare, medical, or human services setting required.
• Minimum of one (1) year of experience utilizing an Electronic Medical Record (EMR) system required.
• Epic EMR experience preferred.
• Knowledge of medical terminology, insurance verification, prior authorizations, and referral processing required.
• Possession of a valid New York State Insurance Assister Certificate preferred.
• Ability to obtain New York State Insurance Assister Certification within six (6) months of employment required.

Physical Requirements

While performing the duties of this job, the employee is regularly required to stand, sit, walk, use hands to finger, handle, or feel; reach with hands and arms; and talk and hear. The employee may occasionally need to stoop, bend, and lift or move up to 25 pounds. Specific vision requirements include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus.

In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.