Referral and Compliance Specialist

The Learning Center for the Deaf Inc•Framingham, MA

3d•$53,040 - $63,440•Onsite

About The Position

The Referral & Compliance Specialist serves as the primary point of entry (“front door”) for individuals and families seeking outpatient or community-based behavioral health services. This role is responsible for managing referral flow, coordinating intake processes, and ensuring access to care. The Specialist acts as a key liaison between patients, families, providers, referral sources, and interdisciplinary teams to promote continuity, safety, and service engagement.

Requirements

Masters Degree in clinical work such as social work or mental health counseling or 3 years equivalent experience
Ability to maintain confidentiality
Comfortable contacting clients by cold calling and informing them of referrals
Bicultural competency and effective interpersonal and communication skills will be necessary to work collaboratively with the team
Competent in using relay services
Ability to work well independently and as part of a team
Microsoft Office skills and ability to work with Mac/Apple computers
Excellent attention to details
Ability to maintain organized records
A minimum of conversational fluency in American Sign Language required, with native, or near-native ASL fluency preferred
ASL Classes may be required based on ASL fluency

Responsibilities

Serve as the initial point of contact for new referrals, patients, families, and community partners.
Conduct intake screenings to gather demographic, clinical background, and presenting needs.
Explain program services, referral expectations, and next steps in a clear, supportive manner.
Determine urgency of need and coordinate appropriate scheduling or escalation when required.
Oversee and track all referrals from receipt through completion, ensuring timely follow-through.
Maintain referral and waitlist systems using electronic databases and tracking tools.
Act as a system navigator and advocate to reduce barriers to care (e.g., interpreters, transportation, financial supports).Ensure referral information is communicated accurately to clinicians, providers, and interdisciplinary teams.
Complete required weekly, monthly, and quarterly state and contract reporting related to referrals, waitlists, service access, and discharge activity.
Enter, track, and reconcile data across platforms including MABHA, CSA Connector, and other state-designated systems.
Collect and verify insurance eligibility, benefits, and referral requirements.
Obtain prior authorizations and approvals in coordination with payers and managed care entities.
Present required clinical information to support authorization decisions.
Support accurate billing processes through complete insurance and registration documentation.
Respond to client questions related to insurance coverage, denials, and financial responsibility.
Maintain accurate and up-to-date clinical and referral documentation in the Electronic Health Record (EHR).
Track and document referral status to promote team awareness and patient safety.
Ensure confidentiality and compliance with HIPAA and clinical documentation standards.
Communicate professionally with patients, families, providers, referral sources, and insurers via phone, email, fax, chat, and mail.
Provide exceptional, accurate insurance and authorization compliance, maintaining complete documentation in the electronic health record, and supporting timely culturally responsive customer service with empathy and respect.
Collaborate closely with billing departments, clinicians, supervisors, and program leadership.
Support complaint resolution and follow crisis communication protocols when needed.
Support onboarding with new staff by ensuring staff are in compliance with insurance (setting NPI, profiles, etc).
Perform additional administrative and program support duties as assigned.