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Become A Referral Specialist

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Working As A Referral Specialist

  • Getting Information
  • Documenting/Recording Information
  • Organizing, Planning, and Prioritizing Work
  • Communicating with Supervisors, Peers, or Subordinates
  • Performing for or Working Directly with the Public
  • Deal with People

  • Unpleasant/Angry People

  • Stressful

  • $44,741

    Average Salary

What Does A Referral Specialist Do At Beth Israel Deaconess Medical Center

* Works with leadership to establish and maintain effective policies and procedures for managed care referrals, revenue cycle, and co-payment collection for the department.
* Ensures that all required managed care referrals for patient visits have been obtained or that a waiver is signed.
* Serves as primary resource on all departmental managed care matters; develops, implements and monitors departmental referral management processes, resource tools, and report findings on a regular basis.
* Represents the practice on hospital based Referral and Registration Operations committees.
* Acts as liaison between the practice and the managed care office and committees.
* Works closely with the physicians organization and the managed care office to communicate managed care principles and policies to the practice.
* Educates and trains administrative assistants and practice assistants in the area of Referral Management and Pre
* Registration.
* Participates in administrative staff meetings reporting statistical referral management and pre-registration measurements and indicators, and communicating referral management information.
* Acts as a managed care resource on the unit to social workers, pharmacists, physicians, nurses and resource specialists for issues regarding managed care and insurance coverage, including commercial payers, Medicare, and radiology pre-certifications

What Does A Referral Specialist Do At Catholic Health Initiatives

* Gather, verify, and process referrals, authorizations, and pre-certifications by working closely with physician(s), patients, and payers.
* Communicate detailed information and answers patients' questions regarding their health care plan; provide answers to billing and insurance clarification questions.
* Set up appointments, coordinate clinic visits, and any special arrangements such as transportation, interpreter services, specialty care, etc.
* Coordinate flow of information between medical clinic and referral authorization department to secure a valid referral for clinic patient.
* Enter referrals, documents communications and action into the system, as appropriate.
* Notify physician(s) and patient when referral is denied, or if additional information is needed.
* Develop and maintain database of referral physician offices preferred by each physician within the clinic.
* Assist Practice Manager with complaint resolution and solutions related to patient referrals.
* Perform other duties as assigned by the practice manager or physician.
* Qualifications

What Does A Referral Specialist Do At Ascension Health

* Obtains authorization on for admissions as required by health plans.
* Enters patient insurance authorizations and any pertinent information from insurance company into the patient account history.
* Documents insurance coverage of services to be provided.
* Notifies case management about interactions with insurance companies regarding services.
* Manages denials or potential denials as described by insurer.
* Monitors and reviews applicable schedule to ensure that authorization and initial length of stay is obtained and on file.
* Responsibilities may vary over time.
* Required to perform other duties as required for the efficiency and effectiveness of the department and job role

What Does A Referral Specialist Do At Centene Corporation

* Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list.
* Route to appropriate staff when needed.
* Verify eligibility and benefits
* Answer phone queues and process faxes within established standards
* Data enters authorizations into the system

What Does A Referral Specialist Do At Conduent

* Complete intake process for requestors for Louisiana long-term care programs:
* Community Choices Waiver
* Long Term Personal Care Services
* Adult Day Health Care Waiver
* Program for All Inclusive Care for the Elderly
* Nursing Facility
* Non
* OAAS Community Resources
* Complete Level of Care Eligibility Tool (LOCET) and other applicable assessments
* Handle incoming and outgoing phone calls to waiver and long term- personal care services (LT
* PCS) requestors and recipients
* Use Conduent and DHH databases to input and update requestors and recipients information and track application process for DHH long-term program options
* Perform post assessment tasks relocated to LOCET mailing and follow-up for EDA and ADHA requestors
* Make appropriate referrals for non
* OAAS community services
* Participate in appeals hearings
* Participate in continuous quality improvement (CQI) process
* Provide consultation and assistance with application processes
* Participate in on-going departmental and Conduent training activities
* Handle TTD/TTY (telecommunications for the hearing impaired) assistance calls
* Provide prompt, professional customer service to ensure that all necessary information is covered and gathered from requestors in a clear, consistent, and professional manner

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How To Become A Referral Specialist

Requirements for social and human service assistants vary, although they typically have at least a high school diploma and must complete a brief period of on-the-job training. Some employers prefer to hire workers who have additional education or experience.


Although a high school diploma is typically required, some employers prefer to hire workers who have relevant work experience or education beyond high school. A certificate or an associate’s degree in a subject such as human services, gerontology (working with older adults), or social or behavioral science is common for workers entering this occupation.

Human service degree programs train students to observe and interview patients, carry out treatment plans, and handle people who are undergoing a crisis. Many programs include fieldwork to give students hands-on experience.

The level of education that social and human service assistants have completed often determines the responsibilities they are given. Those with a high school diploma are likely to do lower level work, such as helping clients fill out paperwork. Assistants with some college education may coordinate program activities or manage a group home.

Although postsecondary education is important, some employers may prefer or allow for applicants who have related work experience. In some cases, candidates may substitute such experience in place of postsecondary education. 


Many social and human service assistants, particularly those without any postsecondary education, undergo a period of on-the-job training. Because such workers often are dealing with multiple clients from a wide variety of backgrounds, on-the-job training in case management helps prepare them to respond appropriately to the different needs and situations of their clients.


For social and human service assistants, additional education is almost always necessary for advancement. In general, advancement to case management or social work jobs requires a bachelor’s or master’s degree in human services, counseling, rehabilitation, social work, or a related field.

Important Qualities

Communication skills. Social and human service assistants talk with clients about the challenges in their lives and assist them in getting help. These workers must be able to listen to their clients and to communicate the clients’ needs to organizations that can help them.

Compassion. Social and human service assistants often work with people who are in stressful and difficult situations. To develop strong relationships, they must have compassion and empathy for their clients.

Interpersonal skills. Social and human service assistants must make their clients feel comfortable discussing sensitive issues. Assistants also need to build relationships with other service providers to become familiar with all of the resources that are available in their communities.

Organizational skills. Social and human service assistants often must complete lots of paperwork and work with many different clients. They must be organized in order to ensure that the paperwork is filed properly and that clients are getting the help they need.

Problem-solving skills. Social and human service assistants help clients find solutions to their problems. They must be able to listen carefully to their clients’ needs and offer practical solutions.

Time-management skills. Social and human service assistants often work with many clients. They must manage their time effectively to ensure that their clients are getting the attention they need.

Some employers require a criminal background check. In some settings, workers need a valid driver’s license.

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Referral Specialist jobs

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Referral Specialist Career Paths

Referral Specialist
Specialist Operations Manager General Manager
Account Manager
5 Yearsyrs
Registered Nurse Team Leader Operation Supervisor
Assistant General Manager
5 Yearsyrs
Front Desk Coordinator Billing Specialist
Business Office Manager
8 Yearsyrs
Service Representative Specialist Case Manager
Career Manager
6 Yearsyrs
Registered Nurse Staff Nurse Nurse Manager
Career Services Director
9 Yearsyrs
Service Representative Account Executive Office Manager
Case Manager
5 Yearsyrs
Social Worker Therapist
Clinical Director
9 Yearsyrs
Licensed Practical Nurse Staff Nurse
Clinical Manager
8 Yearsyrs
Licensed Practical Nurse Registered Nurse Supervisor Nursing Director
Clinical Services Director
11 Yearsyrs
Service Coordinator Program Coordinator Assistant Director
Director Of Admissions
7 Yearsyrs
Specialist Case Manager Social Worker
Director Of Social Services
6 Yearsyrs
Intake Specialist Case Manager Career Manager
Health Care Manager
8 Yearsyrs
Intake Specialist Registered Nurse Nurse Manager
Health Director
9 Yearsyrs
Therapist Registered Nurse Occupational Health Nurse
Health Services Manager
7 Yearsyrs
Billing Specialist Home Health Aid Licensed Practical Nurse
Nursing Director
9 Yearsyrs
Front Desk Coordinator Office Manager
Practice Manager
9 Yearsyrs
Billing Specialist Specialist Project Manager
Program Manager
8 Yearsyrs
Office Administrator Sales Consultant Leasing Consultant
Resident Manager
5 Yearsyrs
Social Worker Program Manager General Manager
Service Director
9 Yearsyrs
Service Coordinator Service Manager Production Manager
Warehouse Manager
5 Yearsyrs
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Referral Specialist Demographics


  • Female

  • Male

  • Unknown



  • White

  • Hispanic or Latino

  • Asian

  • Unknown

  • Black or African American

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Languages Spoken

  • Spanish

  • French

  • Portuguese

  • Italian

  • Swahili

  • Hindi

  • Russian

  • Urdu

  • Tagalog

  • Japanese

  • Kinyarwanda

  • Arabic

  • Swedish

  • Sami

  • Vietnamese

  • Hmong

  • Mandarin

  • Korean

  • Turkish

  • Dari

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Referral Specialist

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Referral Specialist Education

Referral Specialist

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Top Skills for A Referral Specialist


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Top Referral Specialist Skills

  1. Process Referrals
  2. Customer Service
  3. Insurance Companies
You can check out examples of real life uses of top skills on resumes here:
  • Process referrals and task to assigned Case Managers Knowledgeful in ICD10 coding Review Medicaid guidelines Review members file for duplicate request.
  • Managed wide variety of customer service and administrative tasks to resolve customer issues quickly and efficiently.
  • Communicated with various insurance companies in order to obtain patient insurance information.
  • Maintained confidentiality and order of all medical records and correspondence for referrals.
  • Record data entry and provide advocacy services for clients when necessary.

Top Referral Specialist Employers

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Referral Specialist Videos

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