Referral Coordinator

Referral Coordinator

Los Angeles, CA 90026

Overview

Salary Range $24.68 - $28.96 Hourly Position Type Full Time

Description

The Referral Coordinator coordinates and tracks patient referrals for specialty care, diagnostic testing, and other referred services to support timely access to care. This position manages the administrative referral process, including verifying insurance eligibility and covered benefits, obtaining required authorizations, coordinating appointments, and ensuring consultation reports and results are received and routed to the referring provider. The Referral Coordinator works with patients, providers, health plans, and outside organizations to resolve referral issues, address barriers to care, and maintain accurate documentation in the electronic health record.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

1. Coordinates patient referrals from receipt of the provider's order through completion of referred services and receipt of consultation reports or results, following established referral procedures and timelines.
2. Reviews referral orders for administrative completeness, including the requested service, supporting documentation, and provider-assigned urgency. Obtains missing information from the referring provider or clinical team before processing.
3. Verifies patient insurance eligibility, covered benefits, network requirements, and authorization requirements for referred services. Identifies coverage limitations and coordinates appropriate next steps with patients, health plans, and staff.
4. Submits authorization requests with required clinical documentation and monitors their status. Follows up on pending requests, addresses administrative deficiencies, and promptly routes denials or requests requiring clinical review to the appropriate provider or staff member.
5. Identifies specialists and facilities that provide the requested services and accept the patient's coverage. Considers appointment availability, location, language needs, and accessibility when coordinating care.
6. Coordinates referral appointments with patients and receiving providers. Communicates appointment details, required documents, and preparation instructions supplied by the clinical team or receiving facility, and confirms that patients understand the next steps.
7. Prioritizes referral processing and follow-up according to provider-assigned urgency and established timelines. Promptly escalates delays, unavailable appointments, or other concerns that may affect timely access to care.
8. Maintains accurate, current referral records in the electronic health record, documenting authorization status, scheduling activity, patient outreach, barriers, follow-up actions, and referral outcomes.
9. Monitors referral work queues and outstanding referrals daily. Takes action on pending, overdue, canceled, and missed appointments to prevent referrals from being lost to follow-up.
10. Contacts patients to support referral completion and identify barriers such as transportation, language, scheduling, or coverage issues. Coordinates assistance with appropriate staff and community resources.
11. Sends required referral documentation to receiving providers and facilities using approved, secure methods. Confirms receipt and resolves missing or incomplete documentation that could delay care.
12. Requests and tracks consultation reports, diagnostic results, and other referral records. Ensures documents are entered into the patient's medical record and routed to the referring provider for review and follow-up.
13. Completes or closes referrals according to established procedures, documenting the outcome and notifying the referring provider of patient refusals, unsuccessful outreach, or other unresolved barriers requiring clinical direction.
14. Responds promptly and professionally to referral-related calls, messages, and inquiries from patients, providers, health plans, and outside organizations. Provides clear updates and follows unresolved issues through to resolution.
15. Participates in referral quality improvement activities, maintains required tracking reports, and identifies recurring delays or access problems. Recommends practical improvements to referral workflows and coordination.
16. Supports Gracelight's mission and values; treats patients, colleagues, and community partners with respect; protects patient privacy and confidentiality; and follows organizational policies and procedures.
17. Performs other duties as assigned.

Qualifications, Skills & Abilities

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

• High School diploma, GED, or equivalent work experience is required.
• Ability to maintain confidentiality.
• Must have accurate attention to detail.
• Knowledge of medical terminology required.
• Data entry experience and use of electronic health records desired.
• Three years' customer service experience required.
• Bilingual (English/Spanish/Armenian/Korean/Tagalog) strongly preferred.
• Medical Assistant Certification preferred.
• Flexibility to work at any/all of Gracelight's locations.