Description:

MAJOR FUNCTION

The Referral Coordinator is responsible for coordinating and managing patient referrals to internal and external providers to ensure timely access to care, continuity of services, and compliance with clinical, payer, and regulatory requirements. This role serves as a key liaison between patients, providers, insurance carriers, and healthcare partners.

ESSENTIAL RESPONSIBILITES

Referral Processing & Coordination Receive, review, and process provider referral orders for accuracy and completeness Coordinate internal and external referrals in accordance with clinical urgency and organizational guidelines Verify insurance requirements as needed Communicate referral details to patients and receiving providers Patient Communication & Support Serve as a primary point of contact for patients regarding referral status and next steps Provide clear instructions, education, and follow-up to ensure referrals are completed Address patient questions and escalate concerns or delays appropriately Maintain a patient-centered, respectful, and confidential approach Documentation & Compliance Ensure accurate and timely documentation of referrals and authorizations in the electronic health record (EHR) Maintain compliance with CMS, payer guidelines, HIPAA, and organizational policies Track referral outcomes, completion status, and denials Coordination & Collaboration Collaborate with providers, nursing staff, care coordinators, and case management teams Communicate effectively with external specialists, facilities, and diagnostic services Escalate complex or urgent referrals to leadership when necessary Quality & Performance Monitor referral turnaround times and follow established workflows Identify barriers to referral completion and participate in process improvement efforts Support audits and quality improvement initiatives related to referral management

Requirements:

QUALIFICATIONS

Experience in ambulatory care, specialty clinics, or hospital-based referral departments Medical Assistant or healthcare administration background Familiarity with

CPT/ICD-10

codes and payer authorization requirements

OTHER JOB DUTIES

The above job description is not to be construed as a complete listing of the assignments that may be given to any employee, nor are such assignments restricted to those precisely listed in the description. 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