REFERRAL Coordinator

Job Description

Job Description

CENTRA INTERNAL MEDICINE

REFERRAL COORDINATOR – JOB DESCRIPTION

Position Title

Referral Coordinator

Department

Internal Medicine

Position Summary

CENTRA INTERNAL MEDICINE is seeking an experienced and highly organized Referral Coordinator to manage patient referrals and coordinate specialty care. The ideal candidate must have strong knowledge of medical insurance, specialist offices, referral requirements, and healthcare portals.

This position requires someone who can independently identify appropriate specialists based on the provider's recommendation, verify insurance participation, submit and track referrals, and communicate effectively with patients, providers, and specialist offices.

REQUIRED QUALIFICATIONS

These requirements are mandatory. Applicants who do not meet them will not be considered.

• Minimum of 2 years of recent, continuous experience as a Referral Coordinator or in a closely related medical referral position.
• Experience must be current/recent and continuous . Candidates without current hands-on referral experience will not be considered.
• Must have experience working in an Internal Medicine, Primary Care, or medical office setting.
• Strong working knowledge of medical insurance plans and referral requirements.
• Must understand how to determine whether a specialist participates with a patient's insurance plan.
• Must know how to research and locate appropriate specialists based on the provider's referral recommendation.
• Must be experienced with insurance websites and healthcare portals .
• Must be comfortable submitting referrals electronically and following up on referral status.
• Must understand authorizations, referrals, in-network vs. out-of-network providers, and insurance requirements.
• Must be able to communicate with specialist offices and insurance companies.
• Must be able to communicate referral information clearly to patients.
• Strong computer skills and the ability to learn and use multiple medical systems and portals.
• Excellent organization and attention to detail are required.

KEY RESPONSIBILITIES

• Process referrals ordered by physicians and other healthcare providers.
• Review provider recommendations and identify appropriate specialists for the patient's medical needs.
• Research specialists and specialty practices that accept the patient's insurance.
• Verify insurance eligibility, network participation, and referral requirements.
• Submit referrals and/or prior authorizations through insurance and medical portals.
• Contact specialist offices to coordinate appointments and referral requirements.
• Track referrals from the time they are ordered until the patient has been scheduled.
• Follow up on pending, denied, incomplete, or returned referrals.
• Obtain and provide required medical records, clinical information, and documentation to specialist offices when appropriate.
• Communicate with patients regarding referral status, specialist information, and appointment instructions.
• Document referral activity accurately in the patient's medical record.
• Maintain organized referral records and follow up on outstanding referrals.
• Communicate with providers and clinical staff regarding referral issues or insurance requirements.
• Resolve referral problems in a timely and professional manner.
• Maintain patient confidentiality and follow HIPAA requirements.
• Work efficiently in a fast-paced Internal Medicine office.

REQUIRED SKILLS

The successful candidate must be able to:

• Navigate multiple medical insurance portals .
• Navigate specialist and healthcare provider portals .
• Determine which specialists accept specific insurance plans.
• Understand common insurance referral and authorization requirements.
• Work independently with minimal supervision.
• Prioritize multiple referrals and deadlines.
• Communicate professionally with patients, providers, insurance companies, and specialist offices.
• Accurately document all referral activity.
• Handle sensitive patient information professionally and confidentially.

EXPERIENCE REQUIREMENT

Minimum 2 years of recent and continuous referral coordination experience is REQUIRED.

Applicants whose referral experience is outdated, interrupted by a significant gap, or who have only limited exposure to referrals will not be considered.

This is an experienced position. We are looking for a candidate who can step into the role and independently perform referral coordination duties without extensive training.

 

Medical Assistant, Medical Office Administration, Health Information, or related healthcare education is preferred.

IDEAL CANDIDATE

The ideal candidate is dependable, organized, detail-oriented, professional, and experienced in handling referrals from start to finish. The candidate should already understand how medical insurance works and be comfortable researching specialists, using portals, verifying insurance requirements, and resolving referral issues.

CENTRA INTERNAL MEDICINE is seeking an experienced professional who can immediately contribute to the referral process and provide excellent service to our patients and medical team.