Referral Coordinator

Overview

The Referral Coordinator (REFC) reports to the Referrals Manager and provides clerical and administrative support to the health center for the organization of internal and external referrals. This position will support the daily needs of all of the Referral Coordination for the medical department in the health center. The REFC is responsible for ensuring that all appointments, required documentation, insurance information and prior authorizations are established with specialty providers, insurance entities and patients.

Job Title: Referral Coordinator
Department: Medical
Reports to: Referrals Manager
FTE: 100% Full Time
Exempt/Non-Exempt: Non-Exempt

The Referral Coordinator (REFC) reports to the Referrals Manager and provides clerical and administrative support to the health center for the organization of internal and external referrals. This position will support the daily needs of all of the Referral Coordination for the medical department in the health center. The REFC is responsible for ensuring that all appointments, required documentation, insurance information and prior authorizations are established with specialty providers, insurance entities and patients.

• Receives referral requests from providers and communicates with them, or a member of the patient’s care team, as needed
• Obtains prior authorizations for patient referrals to specialists and surgeries. Advises provider if authorization request is denied.
• Communicates with different insurance companies to process referrals appropriately and verifies eligibility of insurance for patients
• Requests appointments from appropriate specialty providers
• Verifies eligibility of insurance for patients
• Communicates with patients and informs them of referral status
• Requests consult notes once patient has been seen by specialist and closes referrals upon receipt.
• Communicates with Specialist regarding referral needs.
• Follows up on referrals with specialty providers and patients.
• Obtains ongoing knowledge, documentation, and updates of appropriate referral resources, required forms and key contact persons
• Reviews and assesses medical records for referral processing.
• Tracks and processes referral using Next Gen Diagnostics and Referrals sections in the A/P section of the SOAP note.
• Prioritizes and processes referrals by urgency or PCP request.
• Completes referral data tracking for Quality Assurance programs.
• Complies with all state and federal laws and regulations, as they pertain to position including; HIPAA, sexual harassment, Scope of Practice, OSHA etc.
• Other duties as assigned.

• Excellent computer skills, preferably with Windows, including Microsoft Office Suite
• Excellent telephone and communication skills
• Must possess excellent organizational, writing, and verbal skills.
• Ability to work independently, set priorities, and work well under pressure.
• Ability to maintain a high degree of confidentiality

• Attention to Detail
• Customer Service
• Insurance Verification
• Record Maintenance
• Research