Referrals Specialist

JOB TITLE: Referrals Specialist

REPORTS TO: Patient Services Manager

DEPARTMENT/LOCATION: Clinical, On-Site 

JOB CLASSIFICATION: Permanent, Full-Time, Non-Exempt.  

LAST MODIFIED: 6/18/2026

POSITION SUMMARY 

As a healthcare Referrals Specialist, you will be an important part of promoting our mission to provide compassionate, world-class urologic care and exceptional experiences for our patients, employees and partners.  Your expertise will drive seamless patient care coordination and optimize referral processes. In this vital role, you will serve as the bridge between patients, providers, and insurance companies, ensuring timely and accurate referrals for specialized services. Your proactive approach and attention to detail will contribute to improved patient outcomes and operational efficiency.

ESSENTIAL FUNCTIONS

• Manage the referral process by coordinating with healthcare providers, patients, and insurance companies to facilitate timely appointments and services
• Verify insurance coverage and benefits through insurance verification procedures to ensure smooth referral approvals
• Maintain accurate medical records, including documentation of referrals, authorizations, and related correspondence
• Utilize medical terminology, CPT (Current Procedural Terminology) codes, ICD (International Classification of Diseases) codes such as ICD-9 and ICD-10, and medical coding standards to process referrals correctly
• Ensure compliance with HIPAA regulations by safeguarding patient information during all stages of the referral process
• Collaborate with medical offices to gather necessary documentation, including medical records and prior authorizations
• Assist in office tasks related to managed care processes, including appointment scheduling and follow-up communication with patients and providers

QUALIFICATIONS & REQUIREMENTS  

• Proven experience in a medical office setting environment with familiarity in medical terminology and records management
• Knowledge of managed care systems, insurance verification procedures, and HIPAA compliance standards
• Strong understanding of CPT coding, ICD coding (ICD-9/ICD-10), and medical billing practices
• Experience handling medical records, insurance authorizations, and referral documentation
• Excellent communication skills to coordinate effectively with healthcare providers, insurance companies, and patients
• Ability to navigate electronic health record (EHR) systems efficiently
• Preferred experience in clinical office settings or familiarity with clinical insurance processes is a plus

WORKING ENVIRONMENT 

This role is based in a fast-paced, patient-focused urology clinic where collaboration is key. Our team of physicians, nurses, and support staff work together in a modern facility equipped with an EHR system and on-site diagnostic services. The atmosphere is professional yet warm, with a shared commitment to delivering compassionate, high-quality care to a diverse patient population.  The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually quiet.  

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Specific vision abilities required by this job include Close vision and Distance vision. While performing the duties of this job, the employee is regularly required to talk or hear.  The employee is frequently required to sit; stand; walk; reach with hands and arms to stoop, kneel and crouch.

COMPANY OVERVIEW 

OUR MISSION: To provide compassionate, world-class urologic care and exceptional experiences for our patients, employees and partners.   

OUR VISION: Curing the world of urologic disorders, one person at a time.   

OUR VALUES: At UCI, we are passionate about patient experience and making the healthcare journey from diagnosis through treatment as easy and stress-free as possible! Through unmatched integration and access for patients, partner hospitals and other physicians in the community, we provide world-class urologic care in an attentive environment where you are at the center of all we do.