Medical Referral Coordinator

Job Description

Job Description

 

Medical Referral Coordinator

Status: Non-Exempt / Full Time / On Site

Medical Specialty: Women's Health - OB/GYN

Job Summary

The Medical Referral Coordinator is responsible for managing the complete lifecycle of patient referrals, ensuring timely, accurate, and coordinated access to specialty care, diagnostic testing, and ancillary services. This position serves as the primary liaison between patients, medical care providers, specialists, insurance companies, and healthcare facilities to facilitate seamless continuity of care while maintaining compliance with organizational policies and all applicable federal and state regulations.

 

Essential Duties and Responsibilities

• Review provider orders, medical records, and clinical documentation to determine referral and diagnostic testing requirements.
• Process incoming and outgoing referrals, ensuring all required clinical documentation, laboratory results, imaging reports, and patient records accompany each referral.
• Collaborate with physicians, advanced practice providers, nurses, and clinical staff to coordinate patient care and referral needs.
• Identify appropriate specialists, facilities, or ancillary service providers based on clinical necessity, insurance participation, and patient preferences.
• Verify patient insurance eligibility and benefits for specialty services and diagnostic procedures.
• Obtain prior authorizations, pre-certifications, referrals, and other payer-required approvals before services are rendered.
• Coordinate and schedule specialist appointments, diagnostic testing, procedures, and follow-up visits.
• Communicate appointment dates, times, locations, preparation instructions, and required documentation to patients.
• Educate patients regarding the referral process, specialist expectations, office policies, and preparation requirements.
• Assist patients with barriers to care, including transportation, language interpretation services, and coordination of community resources when appropriate.
• Maintain accurate referral documentation within the Electronic Health Record (EHR) and practice management systems.
• Monitor referral status to ensure appointments are completed and consultation reports, diagnostic results, and specialist recommendations are received and incorporated into the patient's medical record.
• Follow up with specialty offices, patients, providers, and insurance companies regarding incomplete referrals or outstanding documentation.
• Maintain ongoing communication with patients through appointment reminders, referral updates, and resolution of referral-related questions or concerns.
• Generate reports tracking referral volume, turnaround times, completion rates, authorization status, and referral outcomes.
• Provide regular updates to providers and leadership regarding referral trends, operational issues, and opportunities for process improvement.
• Participate in quality improvement initiatives designed to improve referral efficiency, patient access, and continuity of care.
• Maintain strict compliance with HIPAA, OSHA, CMS, payer requirements, and all applicable federal, state, and organizational policies.
• Safeguard patient confidentiality and protect all protected health information (PHI).
• Perform other duties as assigned.

 

Education and Experience

Required

• High school diploma or GED.
• Minimum of one (1) year of experience in a medical office, healthcare organization, referral coordination, scheduling, patient access, or related healthcare setting.

 

Preferred

• Associate's degree or certification in Healthcare Administration, Medical Assisting, Health Information Management, or a related healthcare field.
• Two (2) or more years of referral coordination or medical scheduling experience.
• Experience working with multiple insurance carriers and managed care organizations.

 

Knowledge, Skills, and Abilities

• Knowledge of medical terminology, anatomy, clinical procedures, and healthcare workflows.
• Strong understanding of insurance verification, referrals, prior authorization, and pre-certification processes.
• Proficiency with Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems such as Epic, Cerner, eClinicalWorks, Athenahealth, or similar platforms.
• Proficient in Microsoft Office applications, including Outlook, Word, Excel, and Teams.
• Excellent organizational skills with the ability to manage a high volume of referrals while meeting deadlines.
• Strong attention to detail and commitment to documentation accuracy.
• Exceptional customer service and patient advocacy skills.
• Effective verbal and written communication with patients, providers, specialists, and insurance representatives.
• Ability to prioritize multiple tasks in a fast-paced healthcare environment.
• Strong critical thinking and problem-solving skills.
• Ability to work independently while contributing effectively as part of a multidisciplinary healthcare team.
• Ability to maintain professionalism, discretion, and confidentiality at all times.

 

Physical Requirements

• Ability to sit or stand for prolonged periods throughout the workday.
• Ability to use a computer, keyboard, telephone, and standard office equipment for extended periods.
• Ability to occasionally lift, carry, push, or pull up to 50 pounds.
• Frequent walking, reaching, bending, and occasional stooping.
• Ability to communicate clearly and effectively in person, virtually, and by telephone.

 

Work Environment

• Primarily performed in a medical office, clinic, or healthcare facility.
• Frequent interaction with patients, healthcare providers, insurance representatives, and external specialty offices.
• Fast-paced environment requiring frequent multitasking, attention to detail, and adherence to established deadlines and regulatory requirements.

 

Core Competencies

• Patient-Centered Service
• Communication
• Organization and Time Management
• Collaboration and Teamwork
• Critical Thinking
• Attention to Detail
• Confidentiality and Professional Ethics
• Adaptability
• Accountability
• Continuous Quality Improvement

 

Benefits : ( Waiting period may apply )

• 401(k) & Profit-Sharing
• Dental Insurance
• Disability Insurance
• Health Insurance
• Life Insurance
• PTO (Paid time off)
• Vision Insurance