Referrals Coordinator

Referral CoordinatorAviva Health is a dynamic and mission-driven federally qualified health center (FQHC). Committed to providing comprehensive and compassionate healthcare services, Aviva Health offers a holistic approach to care, addressing patients' medical, behavioral health, dental, and social service needs. As a vital healthcare resource in the community, Aviva Health fosters a collaborative and supportive work environment where dedicated healthcare professionals have the opportunity to make a meaningful impact on the lives of individuals and families. Join us at Aviva Health and be part of a team that is dedicated to making a difference in the lives of our patients and the community we serve.Position PurposeUnder the supervision of the Referrals and Medical Records Supervisor, the Referral Coordinator facilitates the accurate, timely, and efficient processing of internal and external patient referrals, insurance authorizations, advanced imaging orders, and medication prior authorizations. This position collaborates with providers, patients, insurance carriers, pharmacies, specialty offices, and other healthcare professionals to ensure continuity of care and appropriate access to services.The Referral Coordinator manages multiple requests simultaneously, prioritizes tasks based on urgency, proactively resolves barriers, and maintains accurate documentation throughout the referral and authorization process. This position requires strong organizational skills, attention to detail, sound judgment, and compassionate, professional communication to support a positive patient experience and efficient clinical operations.Essential FunctionsAccurately review and process referral orders through the Electronic Medical Record (EMR), verifying completeness, medical necessity, and insurance requirements. Identify appropriate specialists or facilities when not specified by the provider, following established procedures.Process internal and external referrals in a timely manner, ensuring required clinical documentation, supporting information, and insurance authorizations are obtained and submitted to appropriate specialty offices or facilities.Proactively monitor outstanding referrals and incomplete clinical documentation, following up with providers when chart notes remain incomplete after 72 hours to prevent delays in patient care.Accurately obtain and process insurance prior authorizations for specialty referrals, diagnostic imaging, procedures, and other services, verifying coverage requirements and documenting authorization details in the EMR.Review and process medication prior authorization requests daily, coordinating with providers, pharmacies, and insurance carriers to obtain required information and minimize delays in treatment.Promptly investigate denied or delayed referrals and authorizations, coordinating with providers and insurance carriers to obtain additional documentation, pursue reconsideration, or identify appropriate alternatives.Coordinate Veterans Community Care referrals and authorizations in accordance with applicable program requirements, ensuring accurate documentation, timely processing, and effective communication.Maintain accurate, complete, and timely documentation of referral activities, authorization statuses, communications, and follow-up actions within the EMR to support continuity of care.Consistently monitor referral work queues, pending authorizations, and outstanding requests, using effective time management and sound judgment to prioritize urgent patient needs and meet established deadlines.Communicate professionally and compassionately with patients regarding referral statuses, authorization requirements, scheduling instructions, and potential delays, providing clear information and appropriate assistance.Collaborate effectively with providers, clinical staff, specialty offices, pharmacies, and insurance representatives to clarify orders, resolve discrepancies, and facilitate coordinated patient care.Accurately track referral outcomes, including completed appointments, declined services, unsuccessful contact attempts, and other relevant statuses, ensuring appropriate follow-up and documentation.Follow established organizational policies, payer requirements, Patient-Centered Primary Care Home (PCPCH) standards, HIPAA regulations, and applicable confidentiality requirements while maintaining accurate and secure patient information.Demonstrate proficiency in electronic medical records, referral management systems, and standard computer applications to efficiently process requests, maintain organized workflows, and support department operations.Proactively identify workflow barriers, adapt to changing priorities, and contribute to process improvements while assisting with additional department responsibilities as assigned.Professional QualitiesTakes ownership of responsibilities, follows through on commitments, and consistently meets established expectations and deadlines.Demonstrates accuracy, thoroughness, and consistency when reviewing information, completing tasks, and maintaining records.Communicates clearly, respectfully, and professionally, actively listens, and ensures information is shared appropriately and effectively.Demonstrates compassion, patience, cultural sensitivity, and understanding while supporting patients with diverse backgrounds and healthcare needs.Builds positive working relationships, supports team objectives, and contributes to a respectful, cooperative, and productive work environment.Anticipates challenges, identifies opportunities for improvement, and takes appropriate action to resolve concerns within the scope of the position.Responds constructively to changing priorities, procedures, and operational needs while maintaining professionalism and productivity.Demonstrates ethical judgment, discretion, reliability, and respect while consistently upholding organizational values and confidentiality standards.QualificationsHigh school diploma or equivalent required.Previous experience in a healthcare setting, medical office, referral coordination, insurance authorization, or related administrative position preferred.Experience using electronic medical records and healthcare computer applications preferred.Knowledge of medical terminology, healthcare documentation, referral procedures, insurance verification, and prior authorization processes preferred.Familiarity with insurance payer requirements, specialty referral processes, and applicable healthcare regulations preferred.Ability to accurately interpret referral orders, clinical documentation, insurance requirements, and authorization information.Proficiency in computer applications, data entry, and standard office equipment, with the ability to learn new systems and technology.Strong organizational and time-management skills, with the ability to independently manage multiple responsibilities, prioritize competing deadlines, and maintain accuracy.Effective verbal and written communication skills, including the ability to communicate clearly with patients, healthcare professionals, insurance representatives, and external organizations.Ability to identify discrepancies, investigate issues, exercise sound judgment, and resolve problems within established guidelines.Ability to maintain confidentiality and handle sensitive patient information in accordance with HIPAA and organizational policies.Ability to work independently and collaboratively in a fast-paced healthcare environment.Working ConditionsMust be able to perform the following physical requirements:Remain in a stationary position frequently during the day while performing administrative and supervisory duties.Move or traverse occasionally during the day around the office.Operate equipment frequently during the day: computer and other standard office equipment.Ability to communicate information and ideas clearly and accurately so others will understand; ability to interact with patients and staff clearly.Able to move or transport up to 5 pounds while transporting laptop or office supplies.Work indoors in heat-controlled environment 100% of the day.OSHA Exposure Category – Category #2: The normal work routine involves no exposure to blood, body fluids, or tissues.In-person work during normal business hours.DisclaimerEmployees must be able to perform the essential functions of their position satisfactorily. Aviva Health will make reasonable efforts to accommodate a qualified applicant or employee with a known disability, unless such accommodation creates an undue hardship on the operation of the business. To request a reasonable accommodation, please contact the VP of Human Resources or their designee by email.Ready to join our team? Apply now and take the next step in your career.Aviva Health is an Equal Opportunity EmployerWe are committed to fostering a diverse and inclusive workplace where all qualified applicants receive consideration for employment without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, disability, veteran status, or any other legally protected status.Aviva Health is a Drug-Free WorkplaceTo ensure a safe and secure environment for our employees and patients, Aviva Health maintains a drug-free workplace. All employment offers are contingent upon passing a drug screening and a criminal background check. Compliance with these policies is required throughout employment.