Referral Coordinator

Referral Coordinator

Location: Modesto, California (Fully Onsite)

Role Overview

This position involves analyzing, reviewing, and processing referrals for the authorization of outside medical services. The role requires researching and resolving inquiries from providers, members, and staff regarding specific authorizations. The coordinator will also handle telephone and email communications regarding coverage and eligibility.

Key Responsibilities

• Review, evaluate, and process outside medical service referrals for completeness, accuracy, and timeliness.
• Determine appropriate insurance-based coverages (HMO, Medicare/Medical), service codes, and providers.
• Research referrals from doctors to determine eligibility and obtain required approvals.
• Process claims and understand the revenue cycle and medical billing.
• Provide customer service to referral process stakeholders by responding to inquiries related to authorizations.
• Collaborate with clinical case managers and coordinators to ensure timely authorization processes.
• Ensure outside provider agreements are in place by confirming contract status.
• Code referrals accurately to indicate special claims handling requirements.
• Work within multiple systems to update and edit authorizations.

Required Qualifications

• High School Diploma or General Education Development (GED).
• An Associate's degree or two (2) years of directly related experience in accounting or a related field.
• Previous experience in medical assistance, utilization management/authorization, or coding within a hospital or clinic environment.
• Experience working with health information or medical records/database systems.
• Knowledge of medical terminology, medical coding, or claims processing.
• Proficiency with Excel.
• Must be comfortable with clerical work and lifting/moving paper reems to process physical referrals.
• Customer service, telephone presentation, and problem-solving skills.
• Ability to prioritize work in a high-volume environment.

Preferred Qualifications.

• Familiarity with medical procedures.
• Familiarity with Medicare and Medi-Cal benefits.

Everforth Apex is a world-class IT services company that serves thousands of clients across the globe. When you join Everforth Apex, you become part of a team that values innovation, collaboration, and continuous learning. We offer quality career resources, training, certifications, development opportunities, and a comprehensive benefits package. Our commitment to excellence is reflected in many awards, including ClearlyRateds Best of Staffing® in Talent Satisfaction in the United States and Great Place to Work® in the United Kingdom and Mexico.

Everforth Apex uses a virtual recruiter as part of the application process. Click here for more details. By applying for this job, you agree to receive calls, AI-generated calls, text messages, or emails from Everforth Apex and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy at

Everforth Apex Benefits Overview: Everforth Apex offers a range of supplemental benefits, including medical, dental, vision, life, disability, and other insurance plans that offer an optional layer of financial protection. We offer an ESPP (employee stock purchase program) and a 401K program which allows you to contribute typically within 30 days of starting, with a company match after 12 months of tenure. Everforth Apex also offers a HSA (Health Savings Account on the HDHP plan), a SupportLinc Employee Assistance Program (EAP) with up to 8 free counseling sessions, a corporate discount savings program and other discounts. In terms of professional development, Everforth Apex hosts an on-demand training program, provides access to certification prep and a library of technical and leadership courses/books/seminars once you have 6+ months of tenure, and certification discounts and other perks to associations that include CompTIA and IIBA. Everforth Apex has a dedicated customer service team for our Consultants that can address questions around benefits and other resources, as well as a certified Career Coach. You can access a full list of our benefits, programs, support teams and resources within our 'Welcome Packet' as well, which an Everforth Apex team member can provide.

Everforth Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Everforth Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law.

If you require an accommodation under the Americans with Disabilities Act to participate in an interview with a virtual recruiter or to use our website for a search or application, please contact our Benefits Department at [email protected] or View phone number on click.appcast.io. Please note that this contact information is strictly to be used for medical ADA accommodations and that no other inquiries will be answered.

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