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., 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