What does a referral specialist do?
Referral specialists are responsible for ensuring patients are already cleared for specialty service office visits. They resolve registration, pre-certification, and case-related affairs before the client's appointment. Also, they give support to clinical staff to manage the administrative components of clinical referrals for many services. They must gather relevant information from financial counselors, insurance carriers, and other supplementary staff to make sure the patient's financial responsibility for services are provided. Additionally, they act as a liaison between the patients, physicians, hospitals, health insurance vendors, or other referral sources.
Referral specialist responsibilities
Here are examples of responsibilities from real referral specialist resumes:
- Manage assignments of paying medical bills limit in depth that include organizing and researching regulations as pertain to veterans eligibility.
- Interview patients, evaluate eligibility, collect co-pays, deductibles, including, but not limit to insurance verification.
- Input HIPAA information, call physician offices to verify testing, collect copay's and deductibles.
- Arrange for debt repayments or establish repayment schedules and send out insurance claims with the correct ICD-9 and CPT codes.
- Research referrals and either deny or approve based on information obtain and appropriately identify diagnosis (CPT and ICD-9 coding).
- Maintain confidentiality by following all applicable HIPAA regulations.
- Maintain accurate EMR documentation of all service given to patient under strict confidentiality.
- Coordinate patient data collation with various schedules-appointments for patients upon receipt/confirmation of authorization from referral source.
- Develop effective, trusting relationships with identify veterans, with a focus on facilitating housing placement, stability, and independence.
- Educate and inform each customer on his/her FMLA, worker comp, and short term disability rights.
- Analyze complaints about federal and private employment, security clearances, discrimination, EEOC, FMLA and other employment legal matter.
- Supervise outside billing agency working with claims and appeals, and delegate provider credentialing.
- Research additional information to support medically appropriate appeals if initial reimbursement request is denied.
- Certify in AHLTA and CHCS with booking appointments, referrals, checking in, etc.
- Reviewed/Correct referrals prior to approval of submission to Tricare.
Referral specialist skills and personality traits
We calculated that 17% of Referral Specialists are proficient in Patients, Customer Service, and Medical Terminology. They’re also known for soft skills such as Writing skills, Organizational skills, and Interpersonal skills.
We break down the percentage of Referral Specialists that have these skills listed on their resume here:
- Patients, 17%
Interviewed patients, evaluated eligibility, collected co-pays, deductibles, including, but not limited to insurance verification.
- Customer Service, 12%
Receive incoming calls, letters and E-mail from military families and provide exemplary customer service via active listening and professional communication.
- Medical Terminology, 9%
Possess knowledge of medical terminology and ability to understand patient charts/diagnosis and medical reports.
- PET, 6%
Provided clinical information to CT and PET tech's following GDCC protocols.
- Patient Care, 3%
Assisted in the coordination of patient care by obtaining necessary clinical information from referring providers.
- Data Entry, 3%
Assessed and discerned eligibility, data entry, provide information and referral.
Most referral specialists use their skills in "patients," "customer service," and "medical terminology" to do their jobs. You can find more detail on essential referral specialist responsibilities here:
Writing skills. The most essential soft skill for a referral specialist to carry out their responsibilities is writing skills. This skill is important for the role because "secretaries and administrative assistants write memos and emails when communicating with managers, employees, and customers." Additionally, a referral specialist resume shows how their duties depend on writing skills: "send referral notifications to medical providers and patients regarding referral requests, this would include writing and sending denial letters. "
Organizational skills. Another soft skill that's essential for fulfilling referral specialist duties is organizational skills. The role rewards competence in this skill because "secretaries and administrative assistants keep files, folders, and schedules in order so that an office runs efficiently." According to a referral specialist resume, here's how referral specialists can utilize organizational skills in their job responsibilities: "type 80wpm, ability to multi task in a fast paced environment and process excellent organizational skills. "
Interpersonal skills. referral specialists are also known for interpersonal skills, which are critical to their duties. You can see how this skill relates to referral specialist responsibilities, because "secretaries and administrative assistants interact with clients, customers, or staff." A referral specialist resume example shows how interpersonal skills is used in the workplace: "required a high level of public contact and excellent interpersonal skills. "
The three companies that hire the most referral specialists are:
- Intermountain Healthcare58 referral specialists jobs
- Elevance Health
55 referral specialists jobs
- Centene36 referral specialists jobs
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Compare different referral specialists
Referral specialist vs. Scheduler
A scheduler is responsible for arranging appointments and carrying out reminder calls and correspondence to anyone involved. In a company setting, it is also a scheduler's responsibility to coordinate with various departments and personnel to organize an accurate timetable that will consist of meetings, gatherings, deadlines, or other pressing matters. Furthermore, a scheduler must have attention to detail as one must perform bookkeeping tasks, fix scheduling issues or conflicts, and organize documentation. There are also instances where one must process orders or payments.
While similarities exist, there are also some differences between referral specialists and scheduler. For instance, referral specialist responsibilities require skills such as "pet," "primary care," "process referrals," and "medical services." Whereas a scheduler is skilled in "surgical procedures," "primavera," "p6," and "patient scheduling." This is part of what separates the two careers.
Schedulers really shine in the construction industry with an average salary of $53,150. Comparatively, referral specialists tend to make the most money in the non profits industry with an average salary of $37,335.The education levels that schedulers earn slightly differ from referral specialists. In particular, schedulers are 3.7% less likely to graduate with a Master's Degree than a referral specialist. Additionally, they're 0.2% less likely to earn a Doctoral Degree.Referral specialist vs. Patient care representative
PCRs (Patient Care Representatives) are given responsibilities like updating and verifying patient information after every visit, scheduling and reminding patients about appointments, and informing patients about delays and how long the estimated waiting times will be. They are also responsible for obtaining patients' personal information like their address, contact details, insurance information, and medical and surgical history. They must be able to communicate with patients, family members, and medical staff to give them all the information they need to treat the person looking for medical help.
Each career also uses different skills, according to real referral specialist resumes. While referral specialist responsibilities can utilize skills like "pet," "primary care," "process referrals," and "medical services," patient care representatives use skills like "cash management," "patient registration," "rehabilitation," and "patient insurance."
On average, patient care representatives earn a lower salary than referral specialists. Some industries support higher salaries in each profession. Interestingly enough, patient care representatives earn the most pay in the technology industry with an average salary of $36,400. Whereas referral specialists have higher pay in the non profits industry, with an average salary of $37,335.In general, patient care representatives achieve similar levels of education than referral specialists. They're 4.0% less likely to obtain a Master's Degree while being 0.2% less likely to earn a Doctoral Degree.Referral specialist vs. Medical office administrator
A medical office administrator is responsible for performing administrative and clerical duties within a health care institution, supplying physicians and medical professionals with patients' information, and coordinating with insurance companies. Medical office administrators handle the information and data management system to ensure the accuracy of patients' details, medical history, and treatment plans. They also schedule doctor appointments and cancellations, as well as monitoring the inventory of medical supplies. A medical office administrator submits payment reports, respond to patients' inquiries and concerns, and process billing disputes.
The required skills of the two careers differ considerably. For example, referral specialists are more likely to have skills like "primary care," "process referrals," "medical services," and "social work." But a medical office administrator is more likely to have skills like "provides administrative support," "appointment scheduling," "office equipment," and "medical insurance."
Medical office administrators earn the highest salary when working in the health care industry, where they receive an average salary of $34,449. Comparatively, referral specialists have the highest earning potential in the non profits industry, with an average salary of $37,335.medical office administrators typically earn similar educational levels compared to referral specialists. Specifically, they're 3.9% less likely to graduate with a Master's Degree, and 0.0% less likely to earn a Doctoral Degree.Referral specialist vs. Medical scheduler
A medical scheduler typically works with patients to coordinate appointment dates and times with health care professionals. Medical schedulers often work in hospitals, outpatient care centers, and other medical practices. They perform other duties aside from managing patients' schedules that includes providing patients the information they need about the hospital and its policies, providing patient support, and handling and managing questions from patients. Medical schedulers also act as a link between patients, clinical staff, and referral sources.
Types of referral specialist
Updated January 8, 2025
