Referral Coordinator

Essential Duties and Key Responsibilities

• Receive, review, process, and track all incoming provider referral requests to specialist providers and diagnostic services.
• Schedule patient appointments with specialist providers and confirm receipt of referrals.
• Follow up with patients and providers to ensure timely delivery of care.
• Maintain updated records of patient referrals, statuses, and outcomes in the EMR and referral tracking systems.
• Create and maintain the SFP Health Group Preferred Provider Network list
• Communicate with physicians, nurses, Care Coordinators, and other healthcare staff to obtain necessary patient information.
• Cook up efficient with the Care Coordinator/Care Management team for any surgical requests.
• Review referral details and expectations with patients, ensuring they understand the process.
• Contact patients to inform them when authorizations are received and scheduling is confirmed.
• Establish and maintain relationships with physicians, MAs, Care Coordinators, and office staff at SFP Health Group
• Insurance Verification & Authorization
• Verify patient insurance eligibility, coverage, and benefits for referred services across all lines of business.
• Contact insurance companies to ensure prior approval requirements are met.
• Obtain required prior authorizations, documenting authorization numbers, effective dates, and service limits.
• Maintain up-to-date knowledge of insurance plans, capitations, and educate providers and staff as needed.
• Ensure all referral documentation meets payer-specific criteria and is completed accurately and on time
• Patient Support
• Answer patient inquiries regarding the referral process in a clear and professional manner.
• Provide patients with preparation instructions and expectations for specialist visits.
• Ensure all patient communications prioritize satisfaction and timely care delivery.
• Documentation & Compliance
• Maintain ongoing tracking and documentation of referrals to promote team awareness and patient safety.
• Adhere strictly to HIPAA regulations and maintain patient confidentiality.
• Ensure compliance with internal protocols, payer guidelines, and regulatory standards.
• Identify and resolve issues or delays in the referral process promptly.

Knowledge, Skills, and Abilities

• Education & Certifications: High School Diploma or equivalent required. Certified Medical Assistant (CMA) preferred.
• Experience & Technical Skills: Minimum 2 years of experience as a Referral Coordinator or similar role in a primary care setting. Experience working with multiple payer types and lines of business (Medicare, Medicaid, Managed Care, Commercial, Workers’ Compensation). Proficient in Excel and Availity. Knowledge of Athena and other EMR systems. Knowledge of CPT, ICD-10, and medical terminology
• Interpersonal & Professional Skills: Excellent interpersonal skills with the ability to communicate clearly and effectively with patients and external parties in a courteous and friendly manner. Must be detail-oriented and highly organized. Ability to manage multiple priorities in a fast-paced environment. Knowledge of patient care and examination procedures. Must be able to maintain confidentiality at all times. Bilingual skills are a plus.
• Physical & Mental Requirements: Ability to stand or sit for extended periods of time. Ability to receive and comprehend instructions verbally and/or in writing. Ability to use logical reasoning for simple and complex problem solving. Occasionally requires exposure to communicable diseases or bodily fluids. Occasional travel for clinical activities may be required.