Essential Duties & Responsibilities Referral Management & Coordination:

Process outgoing referrals promptly based on provider orders (e.g., specialty care, diagnostics, therapy). Review, validate, and document referral orders, input referrals and authorizations into the appropriate data systems. Schedule appointments with specialists or service providers, prioritizing high-quality, in-network, and cost-effective options. Track referral status, follow up on incomplete referrals, and ensure timely receipt of consultation reports. Close the referral loop by ensuring reports and documentation are routed to the appropriate provider.

Patient Communication & Navigation:

Educate patients on the referral process, insurance requirements, and expectations. Assist patients in overcoming logistical or administrative barriers (e.g., transportation, language, scheduling). Notify patients of appointment details and authorization status. Provide compassionate, professional support in person and over the phone, reinforcing a positive patient experience.

Insurance & Authorization Processing:

Verify insurance eligibility and determine referral and authorization requirements. Obtain prior authorizations and approvals from health plans as needed. Collaborate with payers and specialists to expedite authorizations and respond to denials or appeals.

Value-Based Care Alignment:

Proactive schedule referrals related to key quality metrics, including HEDIS, STAR, and Quality Improvement (QI) measures (e.g., mammograms, colonoscopies, diabetic eye exams). Support accurate and timely documentation to meet risk adjustment and quality reporting requirements. Track referral patterns and help guide patients to in-network or preferred providers aligned with Accountable Care Organizations (ACOs) and narrow network strategies. Identify, address, and escalate referral delays or barriers that may impact clinical outcomes or contractual performance metrics.

Administrative Support & Documentation:

Maintain accurate documentation of all referral activities in the Electronic Health Record (EHR) system. Log referral status, actions taken, and communications in a timely manner. Generate and distribute referral forms, notifications, and supporting documents.

Care Team Collaboration:

Work closely with physicians, nurses, medical assistants, and care managers to coordinate care. Participate in daily huddles to proactively address upcoming referral needs. Share referral status updates with clinical team members in real-time.

Compliance & Data Privacy:

Uphold HIPAA guidelines and clinic protocols related to data handling and patient confidentiality. Ensure secure communication of patient records to external entities.

Clinic Support & Environment:

Provide clerical support to the clinical team, including managing lobby areas and assisting with PPE protocols. Collaborate with front desk and clinic staff to monitor scheduling and patient flow. Maintain a welcoming and organized patient experience environment. Education & Experience High school diploma or GED required. Minimum of 1-2 years of experience in a medical office, hospital, or clinical setting handling referrals. Working knowledge of medical terminology and insurance processes. Experience with scheduling systems, EHRs (e.g., eClinicalWorks), and insurance authorization procedures. BLS certification required; must be able to respond appropriately in emergencies. Education Requirements Required/Preferred Education Level Discipline Required High school diploma or GED Knowledge, Skills & Proficiencies Proficient in Microsoft Office Suite (Excel, Word, Teams, PowerPoint). Familiarity with insurance portals, including Medicaid, Medicare, and commercial payers. Bilingual in English and Spanish preferred. Strong customer service, organizational, and time management skills. Ability to navigate multiple systems including: eClinicalWorks (eCW). Availity. Cano.

Net (ticketing system). Workday (timekeeping/HR platform). Oracle (expense reporting). Health plan and diagnostic center portals.

Behavioral Expectations:

Serve as a patient advocate and ensure patient needs are met with empathy and professionalism. Actively collaborate with clinic teammates to foster a supportive work environment. Engage with patients respectfully, using preferred names and offering assistance as needed. Promote a culture of compassion, accountability, and continuous improvement. Job Requirements Physical Requirements This position works under usual office conditions. The associate is required to work at a personal computer as well as be on the phone for extended periods of time. Must be able to stand, sit, walk and occasionally climb. The incumbent must be able to work extended and flexible hours and weekends as needed. Physical demands include ability to lift up to 50 lbs. The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Work Conditions Work will involve constant driving/traveling to assigned clinics/territories. Travel Required Amount of Expected Travel Details Yes 0-25% Flexibility to travel to clinical sites as needed. Tools & Equipment Used Computer and peripherals, standard and customized software applications and tools, and usual office equipment. Disclaimer The duties and responsibilities described above are designed to indicate the general nature and level of work performed by associates within this classification. It is not designed to contain, or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of associates assigned to this job. This is not an all-inclusive job description; therefore, management has the right to assign or reassign schedules, duties, and responsibilities to this job at any time. Cano Health is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law. Join our team that is making a difference! 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