Referral Coordinator

Overview:

The Referral Coordinator is responsible for coordinating, tracking, and facilitating patient referrals to specialty care providers and community-based services to ensure timely access to care and continuity of treatment. Working under the direction of the Chief Quality Assurance & Improvement Officer and within established policies, procedures, and regulatory requirements, the Referral Coordinator serves as a central point of communication among patients, providers, specialists, insurance carriers, and support staff.

Essential Job Duties

This position requires strong organizational skills, attention to detail, customer service excellence, and the ability to manage multiple priorities in a fast-paced environment. The Referral Coordinator is responsible for maintaining accurate referral documentation within the Electronic Health Record (EHR), obtaining insurance authorizations, monitoring referral completion, and assisting patients in overcoming barriers to specialty care.

• Receive, review, process, and track referral requests generated by providers and clinical staff.
• Enter and maintain all referral information accurately in the Electronic Health Record (EHR) system.
• Prioritize urgent and time-sensitive referrals and actively coordinate care until appointments are confirmed and completed.
• Schedule specialty appointments and coordinate referrals with external healthcare providers, hospitals, diagnostic centers, and community agencies.
• Obtain prior authorizations and referrals from insurance carriers as required by specialist offices and payer guidelines.
• Request authorization extensions, modifications, or updates when additional services are required.
• Follow up with specialty offices to ensure referral acceptance and appointment availability.
• Coordinate alternative referral arrangements when providers are unable to accept patients.
• Monitor referral status and maintain ongoing communication with patients throughout the referral process.
• Provide patients with specialist contact information, appointment details, preparation instructions, and follow-up requirements.
• Document all referral activities, communications, and outcomes accurately and timely within the EHR.
• Track referral completion and close referral loops by obtaining consultation reports, diagnostic results, and specialist recommendations.
• Ensure receipt and proper routing of specialist reports to ordering providers for review and follow-up.
• Respond promptly and professionally to patient inquiries regarding referrals, authorizations, appointments, and care coordination activities.
• Identify and address barriers to care, including transportation, language access, insurance limitations, and financial concerns.
• Educate patients regarding referral processes, insurance requirements, and follow-up expectations.
• Connect patients with interpretation services, financial assistance programs, prescription assistance programs, and other available resources as appropriate.
• Assist uninsured or underinsured patients by providing information regarding sliding fee scale eligibility and community resources.
• Serve as a liaison between providers, nursing staff, medical assistants, front desk personnel, specialists, hospitals, and insurance representatives.
• Respond to provider inquiries regarding referral status, authorization approvals, specialist reports, and care coordination activities.
• Collaborate with clinical and administrative staff to ensure continuity of care and timely patient follow-up.
• Maintain knowledge of payer requirements, referral guidelines, and specialty network resources.
• Maintain compliance with HIPAA, patient confidentiality standards, organizational policies, and regulatory requirements.
• Participate in quality improvement initiatives related to referral management, care coordination, patient access, and continuity of care.
• Monitor referral performance metrics and assist with audits, reporting, and process improvement activities.
• Maintain accurate and complete documentation in accordance with organizational standards and accreditation requirements.
• Attend required meetings, trainings, and professional development activities.

Non-Essential Job Duties

• Perform other duties and responsibilities as assigned to support patient care and organizational operations.
• Demonstrate professionalism, courtesy, cultural sensitivity, and excellent customer service at all times.
• Support organizational initiatives that improve patient outcomes and patient satisfaction.