Referrals Coordinator

Referrals Coordinator

This is an excellent opportunity to contribute to healthcare service delivery by ensuring medical referrals are processed accurately, efficiently, and in accordance with established benefits and medical necessity guidelines. As a Referrals Coordinator, you will manage incoming requests, maintain accurate medical management records, and connect patients with appropriate healthcare providers. You will collaborate with medical facilities, civilian providers, nurses, and supervisors to obtain information and facilitate timely referral decisions. The role requires strong administrative skills, healthcare knowledge, and the ability to navigate complex referral procedures in a regulated environment. You will also help identify sensitive cases that require specialized attention, supporting appropriate care coordination and compliance. This fully remote position offers the opportunity to make a meaningful contribution to healthcare operations while working within a structured, collaborative team.

Accountabilities

• Referral Processing and Data Entry: Process incoming medical referrals, enter accurate information into medical management systems, and assign appropriate healthcare providers based on established procedures and referral requirements.
• Benefits and Medical Necessity Review: Review referrals for applicable healthcare benefits and medical necessity requirements, identifying cases that need further clinical assessment or additional documentation.
• Referral Escalation and Coordination: Identify sensitive diagnoses and referrals that may require case management, and forward them to the appropriate nurse, supervisor, or case management contact for review and follow-up.
• Medical Coding and Documentation: Assign appropriate ICD-10 diagnosis codes and CPT procedure codes to referrals, ensuring accurate classification and complete documentation.
• Healthcare Provider Communication: Respond to referral-related inquiries, handle incoming calls, and contact military treatment facilities (MTFs) and civilian healthcare providers to obtain missing information or clarify referral details.
• Policy and Process Compliance: Apply relevant healthcare referral procedures, utilization management policies, memoranda of understanding with military treatment facilities, and applicable benefits and coverage guidelines.
• TRICARE Referral Support: Apply knowledge of TRICARE benefits and limitations to help ensure referrals are processed according to established military healthcare requirements.
• Administrative Accuracy and Efficiency: Maintain organized records, manage multiple requests, and ensure referral tasks are processed within established timelines and quality standards.
• Customer Service: Provide clear, professional assistance to individuals and healthcare partners, addressing questions and facilitating the resolution of referral-related issues.

Requirements

• Citizenship and Security Clearance: U.S. citizenship is required due to government contract requirements. Candidates must successfully obtain interim approval for a government security clearance through the National Background Investigation Services (NBIS) process.
• Professional Experience: At least 2 years of customer service experience and/or administrative or data entry experience.
• Healthcare Experience: At least 2 years of healthcare experience, with an intermediate working knowledge of medical terminology, CPT codes, and ICD diagnosis coding.
• Technical Proficiency: Strong proficiency in Microsoft Office applications, including Outlook, Word, PowerPoint, and Excel, with the ability to navigate multiple computer systems and applications efficiently.
• Medical Referral Knowledge: Understanding of referral processing, healthcare benefits, medical necessity requirements, and medical documentation practices.
• Attention to Detail: Strong organizational skills and the ability to maintain accurate records, assign appropriate codes, and handle sensitive medical information responsibly.
• Communication Skills: Clear written and verbal communication skills, with the ability to interact professionally with healthcare providers, internal clinical teams, and other stakeholders.
• Problem-Solving and Prioritization: Ability to recognize complex or sensitive cases, determine when additional review is necessary, and manage multiple tasks accurately within established deadlines.
• Schedule Availability: Ability to work an 8-hour shift scheduled between 8:00 a.m. and 5:00 p.m. Eastern Time, with potential overtime depending on business needs.
• Remote Work Requirements: A dedicated home workspace that protects confidential health information and supports compliance with HIPAA privacy requirements. Home internet service must provide a minimum download speed of 25 Mbps and upload speed of 10 Mbps; a wireless, wired cable, or DSL connection is suggested.
• Preferred Qualifications: Veteran or military spouse status, experience with TRICARE, familiarity with military treatment facility agreements and referral procedures, experience in a managed care environment, and advanced knowledge of medical terminology and ICD-10 coding.
• Location Restrictions: Applicants must reside in the United States and cannot currently reside in Puerto Rico due to government contract restrictions.

Benefits

• Competitive Compensation: Annual base salary ranging from $39,000 to $49,400, depending on location, qualifications, relevant experience, education, and job-related skills.
• Performance Incentives: Eligibility for a bonus incentive plan based on company and/or individual performance.
• Healthcare Coverage: Medical, dental, and vision insurance options to support employees and their families.
• Retirement Savings: Access to a 401(k) retirement savings plan.
• Paid Time Off: Paid time off, company holidays, and personal holidays.
• Family Support: Paid parental leave and caregiver leave.
• Financial Protection: Short-term and long-term disability coverage and life insurance.
• Remote Work Flexibility: Nationwide remote work arrangements, subject to residency and contractual requirements.
• Employee Well-Being: Benefits and programs designed to support personal wellness, healthcare needs, and work-life balance.
• Professional Development: Opportunities to develop healthcare administration, medical referral coordination, and managed care expertise.
• Additional Benefits: Access to other employee programs and resources, subject to eligibility.
• Travel: Occasional travel to company offices may be required for training or meetings.