Referral & Care Coordination Specialist

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Summit Spine and Joint Centers (SSJC) is on track to become the largest comprehensive spine and joint care provider in the Southeast, with over 45 clinic locations across GA, NC, SC, and TN. SSJC offers clinical, surgical, and imaging services to our patients, and we are seeking qualified individuals to join our team to help deliver exceptional care and support across our growing network!

The Referral & Care Coordination Specialist is responsible for managing, obtaining, and tracking primary care referrals required for Interventional Pain services. This role serves as the primary liaison between the interventional pain clinic and external primary care offices, payers, and patients to ensure timely access to care and prevent claim denials due to missing referrals.

This job is a full-time, benefited position at Summit Spine & Joint Centers that reports to the Director of Administrative Operations. Your assigned locations will be in Lawrenceville, GA.

• Identify patients requiring PCP referrals prior to specialty visits or procedures and proactively contact PCP offices to request, obtain, and follow up on referrals
• Verify referral requirements by payer and plan (UHC, Humana, Aetna, etc.)
• Submit, track, and confirm referrals through payer portals and EMR systems, ensuring referrals are in place prior to date of service
• Act as the main point of contact for PCP office staff regarding referral requests, providing PCP offices with clear referral requirements and documentation needs
• Maintain professional, persistent follow-up to minimize scheduling delays
• Inform patients of referral requirements and status, serving as a patient advocate to help navigate the payer and PCP process
• Accurately document referral status in the electronic medical record, ensuring referral logs and tracking tools are appropriately maintained to ensure compliance with all legal and payor rules and requirements
• Additional duties as assigned

• Cohesive customer service skills required.
• Ability to become a core trainer and super user of EHR (E Clinical Works).
• Excellent communication skills, both verbal and written, with ability to read, write, and speak in English fluently. Multilingual is a plus.

• Experience working with PCP offices and payor portals required; experience working within an interventional pain specialty preferred.
• Experience using eClinical
  
  Works preferred.
• 1-3 years of clinical experience required, with a focus on referrals, care coordination, or prior authorization. Experience with CMS & HMO plans preferred.

Entry level

Full-time

Health Care Provider

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