Coordinator, Referrals

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.

• 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 elevate 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.

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…