Referral Coordinator

The Referral Coordinator supports patient care coordination by managing insurance pre-verifications, referral processing, appointment scheduling, and communication between patients, providers, and health plans.

Key responsibilities include:

• Processing outgoing referrals based on provider orders for specialty care, diagnostics, and therapy
• Reviewing, validating, documenting, and entering referrals and authorizations into internal systems
• Scheduling specialist appointments with in-network, cost-effective providers
• Tracking referral status and ensuring consultation reports are received and routed appropriately
• Educating patients on referral requirements, insurance needs, and appointment expectations
• Verifying insurance eligibility and obtaining prior authorizations as needed
• Supporting value-based care initiatives, including HEDIS, STAR, QI, and risk adjustment-related documentation
• Maintaining accurate documentation in the EHR
• Collaborating with physicians, nurses, medical assistants, care managers, and front desk staff
• Upholding HIPAA and patient confidentiality standards
• Providing clerical and clinic support to help maintain smooth patient flow