Coordinator, Referrals

About the role

We are seeking healthcare enthusiasts to join our team of dedicated professionals who make a meaningful impact in patient care coordination. Our goal is to build the best primary care environment for patients.

Responsibilities

• Process outgoing referrals promptly based on provider orders.
• Review, validate, and document referral orders, input referrals and authorizations into the appropriate data systems.
• Schedule appointments with specialists or service providers, prioritizing high-quality, in-network, and cost-effective options.
• Track referral status, follow up on incomplete referrals, and ensure timely receipt of consultation reports.
• Close the referral loop by ensuring reports and documentation are routed to the appropriate provider.
• Educate patients on the referral process, insurance requirements, and expectations.
• Aid patients in overcoming logistical or administrative barriers (e.g., transportation, language, scheduling).
• Notify patients of appointment details and authorization status.
• Provide compassionate, professional support in person and over the phone, reinforcing a positive patient experience.
• Verify insurance eligibility and determine referral and authorization requirements.
• Obtain prior authorizations and approvals from health plans as needed.
• Collaborate with payers and specialists to expedite authorizations and respond to denials or appeals.
• Proactively schedule referrals related to key quality metrics, including HEDIS, STAR, and Quality Improvement (QI) measures.
• Identify, address, and escalate referral delays or barriers that may impact clinical outcomes or contractual performance metrics.
• Maintain accurate documentation of all referral activities in the Electronic Health Record (EHR) system.
• Generate and distribute referral forms, notifications, and supporting documents.
• Collaborate with physicians, nurses, medical assistants, and care managers to coordinate care.
• Participate in daily huddles to proactively address upcoming referral needs.
• Share referral status updates with clinical team members in real-time.
• Uphold HIPAA guidelines and clinic protocols related to data handling and patient confidentiality.
• Ensure secure communication of patient records to external entities.
• Provide clerical support to the clinical team, including managing lobby areas and assisting with PPE protocols.
• Monitor scheduling and patient flow with front desk and clinic staff.
• Maintain a welcoming and organized patient experience environment.

Qualifications

• High school diploma or GED required.
• Minimum of 1–2 years of experience in a medical office, hospital, or clinical setting handling referrals.
• Familiarity with medical terminology and insurance processes.
• Experience with scheduling systems, EHRs (e.g., eClinicalWorks), and insurance authorization procedures.
• BLS certification required; must be able to respond appropriately in emergencies.
• Proficient in Microsoft Office Suite (Excel, Word, Teams, PowerPoint).
• Familiarity with insurance portals, including Medicaid, Medicare, and commercial payers.
• Bilingual in English and Spanish preferred.
• Strong customer service, organizational, and time management skills.
• Ability to navigate multiple systems including:eClinicalWorks (eCW), Availity, Cano.Net (ticketing system), Workday (timekeeping/HR platform), Oracle (expense reporting), and Health plan and diagnostic center portals.

Skills

• Microsoft Office Suite (Excel, Word, Teams, PowerPoint).
• Familiarity with insurance portals, including Medicaid, Medicare, and commercial payers.
• Bilingual in English and Spanish preferred.
• Strong customer service, organizational, and time management skills.
• Ability to navigate multiple systems including:eClinicalWorks (eCW), Availity, Cano.Net (ticketing system), Workday (timekeeping/HR platform), Oracle (expense reporting), and Health plan and diagnostic center portals.

Benefits

Details about benefits will be provided upon hire.

Pay

Details about pay will be provided upon hire.

Schedule

Details about schedule will be provided upon hire.