Lead Referral Coordinator

Career Opportunities with Charles River Community Health Inc

A great place to work.

Non-Exempt, Full Time, Permanent

Site Manager

None

Hybrid (3-4 days on-site, based on managerial discretion)

Band 2 ($22.00 - $29.00/hour)

The mission of Charles River Community Health (CRCH) is to partner with individuals and families so they can thrive and lead healthier lives by delivering the comprehensive, integrated, and equitable primary healthcare that matters most to them. The Lead Referral Coordinator will coordinate collaboratively with primary care practices, specialty practices, referring physicians, primary care physicians, insurance carriers, patients, and other parties to ensure that required referral management referrals and prior authorizations for specified specialty visits and other services are obtained and appropriately recorded in the relevant practice management systems for patient appointments.

The Lead Referral Coordinator will assist in resolving errors, partner with leadership to strengthen training effectiveness and improve operational workflows, and coach and assist Referral Representatives to ensure referrals are processed in a timely manner.

• Assist with the training, education, and coaching of Referral Reps and other internal CRCH staff assigned to the department.
• Identify and address trends that suggest the need for further education.
• Serve as a front line lead resource for the referral staff, and retrain employees as necessary.
• Assist the Site Manager in the development and maintenance of a Referral Representative training program within Med Trainer database.
• Provide feedback to management regarding training materials, methods, and necessary changes; update training materials as necessary.
• Strategize with the Site Manager and Chief Operating Officer on workflow and process improvements to increase the productivity of the team.
• Serve as a backup for managing the Referrals team when Site Manager is unavailable.
• Coordinate all outgoing/incoming referrals and prior authorizations.
• Schedule all referral appointments, including urgent requests, radiology exams, procedures and consultations.
• Verify insurance eligibility and submit insurance referrals and prior authorizations to ensure services are covered.
• Document appointment information on EHR, notify provider and patient with details, and mail out appointment letter.
• Prepare documentation, including office notes and labs, and fax to specialist office for upcoming appointment.
• Collaborate with primary care providers to resolve issues related to specialist availability and patient needs.
• Maintain and build professional relationships with other clinical and operational teams.
• Process insurance referrals and prior authorizations received by fax and phone line from patients and hospitals.
• Scan and drop file insurance referrals in patient charts for easy access to authorization numbers, number of visits, and utilization.
• Maintain up-to-date knowledge of insurance company requirements and where patient’s insurance is accepted.
• Maintain up-to-date phone and fax logs.
• Function as a resource for information and problem solving for patients, primary care providers, referral management program staff, specialists, and Health Center staff.
• Maintain and follow through closing the loop on all tracked referrals.
• Maintain strict adherence to HIPAA regulations, ensuring patient privacy, data security, and confidentiality in all interactions and documentation.
• Understand the mission of the Health Center and strive to work collaboratively with Health Center staff to carry out this mission.
• Conduct regular 1:1 check‑ins with other members of the Referrals team.
• Run monthly Referrals team meetings.
• Attend appropriate meetings to maintain up to date knowledge of Health Center activities and, if unable to attend meetings, follow up with supervisor for information.
• Attend appropriate various external organizational meetings with insurance companies and hospitals to remain up to date on any changes.
• Work closely with Patient Care…