Referral Coordinator

Job Description

Job Description

Company: SFP Health Group
Job title: Referral Coordinator – Primary Care


Division/Department: Health Services
Reports to: VP of Health Services/ Director of Value Base Care

Job Summary:
The Referral Coordinator plays a crucial role in the healthcare system, ensuring patient referrals are managed
and processed effectively. Acting as a liaison between healthcare providers, patients, and insurance
companies, the Referral Coordinator ensures referrals are handled in a timely and accurate manner while
maintaining compliance with payer requirements. This position is responsible for keeping patients within the
network and under the PPN, improving patient satisfaction, and avoiding overutilization of services. The ideal
candidate will have a strong understanding of insurance verification, authorization processes, and the ability
to navigate all lines of business, including Medicare, Medicaid, Managed Care, Commercial, and Workers’
Compensation.

Essential Duties and Key Responsibilities:
Referral Processing & Tracking
• Receive, review, process, and track all incoming provider referral requests to specialist providers and
diagnostic services.
• Schedule patient appointments with specialist providers and confirm receipt of referrals.
• Follow up with patients and providers to ensure timely delivery of care.
• Maintain updated records of patient referrals, statuses, and outcomes in the EMR and referral
tracking systems.
• Create and maintain the SFP Health Group Preferred Provider Network list
Communication & Coordination
• Communicate with physicians, nurses, Care Coordinators, and other healthcare staff to obtain
necessary patient information.
• Coordinate efficiently with the Care Coordinator/Care Management team for any surgical requests.
• Review referral details and expectations with patients, ensuring they understand the process.
• Contact patients to inform them when authorizations are received and scheduling is confirmed.
• Establish and maintain relationships with physicians, MAs, Care Coordinators, and office staff at SFP
Health Group
Insurance Verification & Authorization
• Verify patient insurance eligibility, coverage, and benefits for referred services across all lines of
business.
• Contact insurance companies to ensure prior approval requirements are met.
• Obtain required prior authorizations, documenting authorization numbers, effective dates, and
service limits.
• Maintain up-to-date knowledge of insurance plans, capitations, and educate providers and staff as
needed.
• Ensure all referral documentation meets payer-specific criteria and is completed accurately and on
time
Patient Support
• Answer patient inquiries regarding the referral process in a clear and professional manner.
• Provide patients with preparation instructions and expectations for specialist visits.
• Ensure all patient communications prioritize satisfaction and timely care delivery.
Documentation & Compliance
• Maintain ongoing tracking and documentation of referrals to promote team awareness and patient
safety.
• Adhere strictly to HIPAA regulations and maintain patient confidentiality.
• Ensure compliance with internal protocols, payer guidelines, and regulatory standards.
• Identify and resolve issues or delays in the referral process promptly.
Knowledge, Skills, and Abilities:

Education & Certifications:
• High School Diploma or equivalent required.
• Certified Medical Assistant (CMA) preferred.
Experience & Technical Skills:
• Minimum 2 years of experience as a Referral Coordinator or similar role in a primary care setting.
• Experience working with multiple payer types and lines of business (Medicare, Medicaid, Managed
Care, Commercial, Workers’ Compensation).
• Proficient in Excel and Availity.
• Knowledge of Athena and other EMR systems.
• Knowledge of CPT, ICD-10, and medical terminology

Interpersonal & Professional Skills:
• Excellent interpersonal skills with the ability to communicate clearly and effectively with patients and
external parties in a courteous and friendly manner.
• Must be detail-oriented and highly organized.
• Ability to manage multiple priorities in a fast-paced environment.
• Knowledge of patient care and examination procedures.
• Must be able to maintain confidentiality at all times.
• Bilingual skills are a plus.

Physical & Mental Requirements: (check all that apply)
Ability to stand or sit for extended periods of time.
Ability to receive and comprehend instructions verbally and/or in writing.
Ability to use logical reasoning for simple and complex problem solving.
Occasionally requires exposure to communicable diseases or bodily fluids.
Occasional travel for clinical activities may be required.
The information listed above is not comprehensive of all duties/responsibilities performed. This job description is not
an employment agreement or contract. Management has the exclusive right to alter this job description at any time
without notice.