Coordinator, Referrals

It's rewarding to be on a team of people that truly believe in making an impact!

We are committed to building the best primary care environment for patients and are seeking healthcare enthusiasts to join us.
** Job Summary
** The Referral Coordinator plays a vital role in supporting patient care coordination by managing insurance pre-verifications, referral processing, appointment scheduling, and communication between patients, providers, and health plans. This individual ensures timely and accurate handling of all internal and external referrals, authorizations, and follow-up activities. The Referral Coordinator serves as a key liaison among clinics, specialists, and insurance carriers, while upholding a patient-centered and service-oriented approach.
** 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., eClinical

Works), and insurance authorization…