A referral should never be a dead end. It's a promise that a patient who needs a specialist, a mammogram, or a colonoscopy will actually get there - and that the results will make it back to their provider in time to matter. The Clinical Support Specialist is the person who keeps that promise. If you take pride in the fact that nothing falls through the cracks on your watch, you will thrive here. What You'll Do Referral Coordination & Closed-Loop Tracking - Receive, triage, and process all patient referrals, prioritizing by clinical urgency.
- Schedule specialty visits, radiology, diagnostics, and procedures, accounting for insurance, network, transportation, and language needs.
- Send complete clinical information - notes, labs, imaging, and the referral question - to the specialist in advance.
- Review the referral process with patients, confirm understanding, and address barriers; deliver reminders and reschedule no-shows.
- Track every open referral to completion: maintain an active referral log, monitor reports not yet received, and conduct persistent documented follow-up until documentation is in hand.
- Route completed reports to the referring provider for review and document closure in the EHR.
Cancer Screening Partnerships - Support cervical, breast, and colorectal screening partnerships .
- Ensure abnormal results move rapidly to diagnostic follow-up, with no abnormal result untracked.
Prior-Authorizations - Initiate, submit, and track prior authorizations for imaging, procedures, and occasionally medications.
- Compile documentation to meet payer medical necessity criteria; verify eligibility and benefits.
- Manage denials - coordinate peer-to-peer reviews, support appeals, and identify alternatives including patient assistance and sliding fee resources.
Skills Needed to Succeed - Exceptional attention to detail - accuracy in clinical, insurance, and scheduling data is non-negotiable.
- Organization and follow-through - manage a high-volume aging referral queue without losing a single case.
- Strong work ethic and ownership - persistence in chasing a report that's three weeks late; initiative to solve problems unprompted.
- Time management - sort urgent from routine and handle both in the same day.
- Clear, empathetic patient communication across varied health literacy and cultural backgrounds; professional communication with specialists and payers.
- Technical knowledge - medical terminology, cancer screening modalities and result terminology, Medicaid/Medicare/managed care and sliding fee, prior authorization and appeals workflows.
- Resourcefulness and adaptability - find the appointment, the authorization, or the funding source when the obvious path is blocked.
Qualifications Required - High school diploma or GED.
- [1-3] years in healthcare - referral coordination, patient navigation, medical assisting, scheduling, prior authorization, or patient access.
- EHR proficiency and demonstrated discretion with protected health information.
- Reliable transportation required
- Experience with referrals and prior authorization
Preferred - Bilingual English/Spanish strongly preferred - fluency sufficient for patient education.
- Experience in a medical office preferred
- Familiarity with medical terminology preferred
- Certification (CMA, CCMA, Patient Navigator, Certified Referral Specialist) or degree in health administration, public health, or related field.
Pay Range- $17.00- $21.00 per hour (based on experience and qualifications) Benefits: - Paid-time-off
- Fully funded Health Insurance
- Continuing education time and funding
- Group Health /Life/Dental/Vision/Disability
- 403B Retirement Plan with 3% match
- 12 Paid Holidays
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