Referral Coordinator

Referral Coordinator

The Referral Coordinator is responsible for managing the patient referral process from initiation through completion. This position serves as a key liaison between patients, providers, specialists, insurance plans, external service providers, and internal care teams to facilitate timely access to specialty care, diagnostic services, behavioral health, dental, and other referred services. The Referral Coordinator supports continuity of care by reviewing and prioritizing referral requests, obtaining insurance authorizations, coordinating appointments, communicating referral status to patients and providers, resolving barriers to care, tracking referrals through completion, and ensuring referral outcomes and consultation reports are received and accurately documented in the electronic health record (EHR).

Essential Job Functions

1. Manages referrals from order through completion for specialty care, diagnostic testing, behavioral health, dental, and other services as directed by providers, including coordination, tracking, follow-up, and closure of the referral loop.
2. Reviews referral orders for completeness, accuracy, urgency, required documentation, and payer requirements.
3. Prioritizes emergent, urgent, and time-sensitive referrals and follow through until appointments, authorizations, or next steps are confirmed.
4. Verifies patient insurance eligibility, benefits, network status, referral requirements, and prior authorization requirements; obtain authorizations, pre-certifications, extensions, or modifications from insurance plans as needed.
5. Coordinates appointments with specialists and external service providers, ensure required clinical information is transmitted securely and accurately, and communicate referral details, appointment information, preparation instructions, and follow-up requirements to patients in a clear and timely manner.
6. Documents all referral activity, patient contacts, provider communications, authorization details, appointment information, outcomes, and status updates in the electronic health record (EHR), and respond to patient, provider, specialist, and staff inquiries regarding referral status in a professional and timely manner.
7. Notifies providers and care team members of referral barriers, delays, denials, missed appointments, incomplete referrals, or abnormal results in accordance with organizational policy.
8. Assists patients in overcoming barriers to care, including transportation, language access, insurance issues, financial concerns, or difficulty accessing specialty services.
9. Maintains current knowledge of specialty providers, community resources, referral forms, payer requirements, and organizational referral workflows.
10. Maintains patient confidentiality and comply with HIPAA, organizational policies, payer requirements, and all applicable federal, state, and local laws and regulations.
11. Participates in audits, reporting, training, workflow improvement, and quality improvement initiatives related to referral management.
12. Maintains strict adherence to scheduled work hours with regular and reliable attendance.
13. Performs other duties as assigned.

Education and Experience

1. Completion of a medical assistant, certified nursing assistant, healthcare administration, or other related healthcare training program; or an equivalent combination of education, training, and demonstrated competency in referral coordination, insurance verification, patient access, or related healthcare functions is required.
2. Demonstrated ability to organize and prioritize work, communicate effectively with patients and interdisciplinary team members, and perform multiple responsibilities accurately in a fast-paced healthcare environment is required.
3. Knowledge of medical terminology and one (1) to three (3) years of experience with referral coordination, insurance verification, patient access, or in a medical office or other healthcare setting is preferred.
4. Experience in a Federally Qualified Health Center (FQHC) or community health center is preferred.

Certifications / Licenses

Current certification as a Medical Assistant (MA), Certified Clinical Medical Assistant (CCMA), Certified Nursing Assistant (CNA) is preferred.

Equal Employment Opportunity