Position Summary:

The Referral Coordinator is responsible for processing, tracking, and following up on patient referrals to specialists, imaging centers, and other healthcare facilities. This position helps ensure referrals and authorizations are completed accurately and in a timely manner while keeping patients and providers informed.

Key Responsibilities:

Process referrals ordered by providers accurately and promptly. Submit prior authorization requests to insurance companies and medical groups when required. Verify patient insurance eligibility and referral/authorization requirements. Obtain appropriate diagnosis codes, CPT codes, provider information, and supporting medical records. Send referrals, authorizations, chart notes, lab results, imaging results, and other necessary documentation to specialists. Document all referral activity and authorization information in the patient's medical record. Follow up on pending referrals and authorizations until completed. Monitor denied, redirected, expired, or incomplete authorizations and take appropriate follow-up action. Contact patients with referral information and instructions for scheduling. Communicate with specialists, insurance companies, IPAs/medical groups, providers, and office staff regarding referral status. Review incoming specialist reports and ensure appropriate documentation is added to the patient's chart. Maintain referral work queues and prevent referrals from becoming overdue. Notify providers when there are referral problems, denials, or delays requiring provider action. Maintain patient confidentiality and follow HIPAA requirements. Use professional communication when speaking with patients, providers, and outside offices. Assist with other administrative or patient-care coordination duties as assigned.

Qualifications:

High school diploma or equivalent required. Previous medical office, referral, authorization, or insurance experience preferred. Knowledge of medical terminology, insurance plans, HMOs/PPOs, prior authorizations, CPT/ICD-10 codes, and electronic medical records is preferred.

Important Expectations:

The Referral Coordinator should be organized, detail-oriented, professional, able to multitask, and responsible for following referrals through completion rather than only submitting the initial request.

Job Type:

Full-time Benefits:

401(k) 401(k) matching Dental insurance Health insurance Life insurance Paid time off Vision insurance

Experience:

Customer service: 2 years (Preferred) Medical terminology: 1 year (Preferred) Computer skills: 2 years (Preferred)

Work Location:

In person