Referral Specialist

Overview

Receive and process referrals from hospitals, physicians, skilled nursing facilities, and community partners. Review referral documentation for completeness, including face-to-face encounters and physician orders. Verify insurance eligibility, benefits, and coverage for home health services. Obtain prior authorizations in accordance with payer and Medicare guidelines. Coordinate with clinical staff to ensure timely start of care (SOC). Communicate with referral sources, patients, families, and caregivers regarding service status.

Enter and maintain accurate referral and intake information in the EMR system. Track referral outcomes and follow up on pending or delayed cases. Ensure compliance with Medicare, Medicaid, and payer regulations. Maintain HIPAA compliance and confidentiality standards.

• Receive and process referrals from hospitals, physicians, skilled nursing facilities, and community partners
• Review referral documentation for completeness, including face-to-face encounters and physician orders
• Verify insurance eligibility, benefits, and coverage for home health services
• Obtain prior authorizations in accordance with payer and Medicare guidelines
• Coordinate with clinical staff to ensure timely start of care (SOC)
• Communicate with referral sources, patients, families, and caregivers regarding service status
• Enter and maintain accurate referral and intake information in the EMR system
• Track referral outcomes and follow up on pending or delayed cases
• Ensure compliance with Medicare, Medicaid, and payer regulations
• Maintain HIPAA compliance and confidentiality standards

• High school diploma or GED required (associate degree preferred)
• Minimum 1–2 years of experience in home health, intake, or healthcare referrals preferred
• Knowledge of Medicare, Medicaid, and managed care home health requirements
• Familiarity with OASIS, physician orders, and home health eligibility criteria preferred
• Experience with home health EMR systems (Axxess) a plus
• Strong organizational, communication, and customer service skills

• Excellent attention to detail
• Ability to manage multiple referrals simultaneously
• Strong follow-up and problem-solving skills
• Professional communication with referral sources and payers
• Ability to work independently and as part of a team