Patient Referral Coordinator

The Patient Referral Coordinator manages the complete referral cycle for FQHC patients, including specialist referrals, diagnostic services, insurance authorization, appointment coordination, follow-up, and documentation. This position ensures patients receive timely access to medically necessary care while complying with payer requirements, referral protocols, HIPAA, and health-center policies.

Essential Duties and Responsibilities

• Receive referral orders from providers and verify required clinical information.
• Review referrals for completeness, accuracy, urgency, diagnosis, and supporting records.
• Enter and update referrals in the EHR and referral-management system.
• Send referral packets, medical records, authorization requests, and other required documents to specialists or facilities.
• Confirm that the receiving specialist or facility accepts the referral and has all necessary information.
• Verify insurance eligibility, benefits, network status, and referral or authorization requirements.
• Submit prior-authorization requests to insurance plans and track approvals, denials, pending requests, and expiration dates.
• Obtain referrals, authorizations, or approval extensions from insurance companies when required.
• Communicate with specialists, hospitals, testing facilities, managed-care plans, providers, and patients to resolve delays or missing information.
• Schedule appointments when permitted and communicate appointment details to patients.
• Follow up with patients who have not scheduled or completed referred services.
• Track urgent referrals through completion and escalate overdue or high-risk cases.
• Document every contact, submission, approval, denial, scheduling effort, and patient notification in the EHR.
• Close the referral loop by obtaining specialist reports and forwarding results to the referring provider.
• Assist uninsured and underinsured patients with financial-assistance options, sliding-fee programs, transportation, interpretation, and other access barriers.
• Maintain confidentiality of protected health information and release records only according to authorization and policy.
• Prepare referral-status reports and participate in quality-improvement activities.