Referral Coordinator

The Referral Coordinator is responsible for coordinating, processing, and obtaining prior authorizations for a variety of medical referrals for services/procedures as requested by medical providers. The Referral Coordinator collaborates with other referral staff, medical providers, and patient care support staff to effectively communicate and ensure successful tracking and coordination of referrals.

• Monitors Electronic Health Record (EHR) tasks throughout the day to capture referral requests in real time.

• Verifies insurance information and performs eligibility checks by telephone or electronically, as appropriate, for referral purposes.

• Obtains authorizations for patient referrals to specialists, diagnostic testing, and surgeries

• Gathers pertinent information as needed via EHR or from clinical team to accurately complete pre-authorization/referral process.

• Prepares and accurately processes referral and pre-authorization paperwork; ensures that referrals are addressed in a timely manner, prioritizing urgent items appropriately.

• Produces and submits all appropriate notification letters for patients and clinicians, as required.

• Ensures complete tracking and follow-up on all referral requests and specialty report requests.

• Answers, responds and documents phone calls, requests and questions from patients in a timely manner; reviews details and expectations about referrals with patients.

• Responds to clinical support staff questions, requests and concerns regarding the status of patient referrals, care coordination or follow-up status.

• Utilizes third party payer/insurance portals as needed.

• Schedules referral appointments directly on behalf of patients, as needed.

• Properly follow-up with provider and patient regarding denials to referral requests.

• Maintains confidentiality of PHI by following all applicable Health Insurance Portability and Accountability Act (HIPAA) regulations.

• Performs other related duties as required

• High school diploma or GED.

• A minimum of three years of medical records and/or clerical experience in an outpatient medical setting.

• Ability to work collaboratively with patients, medical staff, co-workers and the public and ability to work independently and as part of a team.

• Exceptional phone and customer service skills; strong verbal and written communication, interpersonal, organizational, time management, and multi-tasking  skills.

• Ability to organize and prioritize work as required and to work with a high attention to detail and accuracy

• Working knowledge of EHR and registration/billing software desired.

• An understanding of insurance providers, their portals and their expectations for authorization approvals preferred.