Referral Coordinator

Job Description

Job Description

Job Summary

A non-exempt position responsible for coordinating incoming and outgoing patient referrals under the supervision of the department supervisor. The person in this position works under general supervision. This position is responsible for various shifts and may be subject to over 40 hours per week as required. Manages the referral process from receipt through completion, including reviewing referral documentation to determine the appropriate visit type and priority, verifying insurance eligibility and benefits, obtaining prior authorizations and pre-certifications, scheduling patients with specialists and diagnostic facilities, and assembling and routing supporting clinical documentation. Serves as liaison between patients, referring providers, outside offices, and insurance carriers. Serves as backup to the front desk as needed, including patient check-in and check-out, registration and demographic and insurance updates, appointment scheduling, telephone coverage, and collection of copays and balances. Continuing responsibilities include tracking pending referrals and authorizations through to closure, obtaining outside records and results, EMR documentation, and clerical work as necessary.

Minimum Education

• High School Diploma or equivalent; completion of medical office administration coursework preferred.

Minimum Work Experience

• At least one year of current experience within the last three years in a comparable job classification required.
• Experience with referral processing, prior authorization, insurance verification, or front office reception in a physician office setting preferred.

Required Licenses or Certifications

• None required. Certification as a Certified Medical Administrative Assistant (CMAA) or equivalent preferred.

Required Understanding of Clinical Documentation

• Basic working understanding of clinical notes, consultation letters, and diagnostic reports sufficient to identify the reason for referral, the referring diagnosis, and the requested service.
• Ability to locate and interpret key elements of a referral packet, including problem lists, ICD-10 diagnosis codes, ordered tests, and pertinent results, in order to route the referral to the correct provider and visit type.
• Familiarity with common pulmonary and sleep diagnoses and the studies and follow-up intervals typically associated with them.
• Ability to apply practice-defined scheduling criteria and urgency guidelines to referral documentation, and to recognize documentation indicating a potentially urgent or acute presentation that must be escalated to a physician or clinical staff before the appointment is set.
• Understands that this position does not exercise independent clinical judgment; all questions of medical necessity, acuity, or appropriateness of care are referred to licensed clinical staff.

Required Skills, Knowledge, or Abilities

• Educated on and compliant with HIPAA regulations; maintains strict confidentiality of client information.
• Working knowledge of commercial, Medicare, and Medicaid referral and authorization requirements, including medical necessity criteria and payer-specific documentation.
• Familiarity with ICD-10 and CPT coding sufficient to submit accurate authorization requests.
• Proficiency with EMR, referral and authorization portals, practice management scheduling systems, and standard office software.
• Ability to interact courteously and professionally with patients, families, and outside offices in person and by telephone.
• Ability to work effectively within role independently and with other team members.
• Ability to organize, prioritize, and complete work in a timely manner while managing a high volume of pending referrals alongside front desk coverage.
• Ability to read, write and effectively communicate in English.
• Ability to understand medical/surgical terminology.