Referral Coordinator

Job Description

Job Description

Job Posting: Referral Coordinator / Insurance VerifierDepartment: Vista Physician Group – ClinicsFLSA Status: Non‑ExemptReports To: Manager of Business OperationsPosition SummaryThe Referral Coordinator / Insurance Verifier plays a vital role in ensuring patients receive timely, coordinated care while supporting accurate reimbursement. This position is responsible for managing provider referrals and verifying patient insurance coverage, benefits, and authorization requirements. Serving as a key liaison between patients, providers, and insurance carriers, this role requires strong attention to detail, a working knowledge of insurance processes, and excellent communication skills to support efficient patient flow and regulatory compliance.Essential Duties and ResponsibilitiesReceive, review, and process incoming and outgoing referrals in compliance with payer and organizational requirementsVerify patient insurance eligibility, benefits, coverage limitations, and authorization requirements prior to services being renderedObtain prior authorizations and referrals from insurance carriers, primary care providers, and specialists as requiredAccurately document insurance verification details, referral status, authorization numbers, and related communications in the EHR or practice management systemCommunicate clearly with patients regarding insurance coverage, referral requirements, financial responsibility, and next steps in scheduling careCoordinate with clinical staff, scheduling teams, and external provider offices to ensure referrals are complete and services are scheduled appropriatelyContact insurance companies to clarify benefits, resolve discrepancies, appeal authorization or referral denials, and confirm payer policiesMonitor referral and authorization turnaround times to minimize delays in patient careMaintain compliance with HIPAA, payer contracts, and organizational policies when handling protected health information (PHI)Identify and escalate insurance coverage issues, referral denials, or incomplete documentation to appropriate leadership or billing teamsSupport billing and revenue cycle processes by ensuring all referrals and authorizations are complete and accurate prior to claim submissionStay current on changes in insurance plans, referral guidelines, and authorization requirements for common payersSupervisionPerforms job duties with minimal supervisionInternal & External RelationshipsInternal InteractionsDemonstrates professionalism, respect, and collaboration with coworkers and managementWorks collaboratively and provides assistance to team members as neededExternal InteractionsTreats patients and customers as a priority in all interactionsCommunicates effectively and compassionately to address patient questions and concernsDemonstrates respect and sensitivity to diverse cultures, backgrounds, and needsEquipment UsedStandard office equipment including computer, telephone, fax machine, and copierWorking Environment & Physical RequirementsPrimarily seated work with occasional walking, standing, bending, lifting, and carrying (up to 50 lbs)Visual and hearing acuity required (corrective devices permitted)May be exposed to infectious or contagious diseasesMay be required to handle emergency or crisis situationsOccasional irregular hours, on‑call, or call‑in support may be requiredMay be required to wear personal protective equipment (PPE) as necessaryBloodborne Pathogen Exposure: No exposureMinimum QualificationsEducationHigh school diploma or equivalentExperienceMinimum of two (2) years' experience in a hospital or medical‑related environmentWorking knowledge of medical insurance and the insurance industry requiredAt least one (1) year of customer service experienceSkills & TrainingProficiency with computers and standard office equipmentStrong organizational skills, attention to detail, and communication abilitiesPatient Population ServedAll age groups: adolescent, adult, pediatric, and geriatricTravel & On‑Call RequirementsTravel to other Vista Health sites may be requiredOn‑call and call‑in support required as needed to meet departmental or facility staffing needsLicensure / CertificationNo licensure or certification requiredEqual Opportunity Statement & DisclaimerVista Health System is an equal opportunity employer. This job description is not a contract of employment, and job duties may be modified or expanded based on organizational needs.