Clinic Referral Coordinator

JOB SUMMARY:

The Referral Coordinator manages and tracks patient referrals to specialists, diagnostic services, and external providers to ensure timely access to care. Responsibilities include coordinating appointments, monitoring referral status, and ensuring required documentation and results are communicated to support continuity of care and prevent treatment delays.

RESPONSIBILITIES (ESSENTIAL FUNCTIONS):

Coordinate and manage the referral process for assigned clinics to ensure referrals are processed accurately, timely, and in accordance with DRH policies and procedures.

Assist in removing barriers to patient access by ensuring referrals are appropriately prioritized and processed based on patient needs, provider instructions, urgency, and appointment availability.

Review incoming referrals for completeness and accuracy, including patient demographics, insurance information, diagnosis, clinical documentation, and provider orders.

Obtain and verify required information and documentation needed to process referrals and schedule patients appropriately.

Coordinate insurance authorization and referral requirements as applicable, including identifying payer-specific requirements and ensuring necessary authorizations are obtained prior to scheduling or services being provided.

Communicate with referring providers, receiving providers, insurance companies, patients, and other departments to obtain missing information, resolve referral issues, and facilitate timely patient care.

Monitor referral work queues and maintain accurate tracking of pending, scheduled, completed, and outstanding referrals.

Follow up on referrals that are pending due to missing information, authorization requirements, inability to contact the patient, provider review, or other barriers to scheduling.

Appropriately prioritize urgent or time-sensitive referrals and escalate concerns to the appropriate provider or leader when necessary.

Demonstrate appropriate judgment when requesting leadership or provider support for referral issues outside the scope of the Referral Coordinator role.

Communicate and disseminate information regarding referral-related updates, workflow changes, downtime, system issues, or other potential disruptions to routine operations.

Maintain accurate documentation of referral activity, patient contacts, authorizations, scheduling attempts, and other required information in the electronic medical record and applicable referral systems.

Contact patients regarding referrals, appointments, required information, insurance requirements, and other referral-related matters while maintaining professionalism and patient confidentiality.

Schedule and coordinate patient appointments with appropriate providers and departments based on referral information, clinical needs, provider instructions, and established scheduling guidelines.

Assist patients and referring offices with questions regarding the status of referrals and provide appropriate information within the scope of the position.

Identify referral backlogs, delays, or workflow concerns and communicate them to leadership in a timely manner.

Work collaboratively with clinic staff, providers, nurses, Clinic PERs, Central Scheduling, insurance representatives, and other departments to promote timely patient access and continuity of care.

Assist with coverage of referral functions across clinics as needed to maintain timely processing and prevent delays in patient care.

Perform PER/front-desk duties as needed to support clinic operations during staffing shortages or periods of increased volume.

Travel to and provide referral or clinic coverage at other DRH locations as needed.

Protect patient privacy and confidentiality and comply with all applicable HIPAA requirements and…