Referral Coordinator

1 month ago

Lumberton, United States Southeastern Integrated Care LLC Full time
Job DescriptionJob Description



Job Summary:

The Referral Coordinator will be responsible for managing and coordinating patient referrals to specialists or other healthcare providers. This role requires excellent communication skills, strong attention to detail, and the ability to collaborate with patients, healthcare professionals, and insurance companies. Performs a wide range of administrative duties to include referral processing, patient registration, verification of benefits, insurance authorizations, patient appointment scheduling, program communication to potential candidates, and communication with referral sources. Ensures excellent customer service and supports the mission and vision of our Advance Medical Home Primary Care facility.

Essential Duties and Responsibilities:

  • Coordinate and manage all aspects of the referral process for patients in the advanced medical home primary care office.
  • Responsible for the tracking, coordination, and communication of patient referrals. Maintain accurate and up-to-date records of referral activities and ensure proper documentation.
  • Ensures complete and accurate patient registration, including demographics and current insurance information
  • Ensures that referrals are addressed in a timely manner and that all required referral paperwork and documentation are completed accurately and in a timely manner.
  • Review patient medical records and gather necessary information to initiate the referral process
  • Verify insurance coverage and obtain necessary authorizations for referrals. This may include making phone contact with insurance companies to ensure verification of benefits and prior authorization approval requirements are met.
  • Communication with referral sources, such as, but not limited to, outside specialty clinics, diagnostic imaging centers, pain clinics, behavioral health facilities, inpatient/outpatient intensive treatment, etc. to ensure patient information/registration is complete
  • Reminds patients of scheduled appointment/s and notes this under patient case in patients’ chart accordingly for reference
  • Communicate and review details and expectations of the referral process, answer questions, and address concerns with patient regarding the referral process and order
  • Communicates updates, including but not limited to, reason for referral, date of appointment, time of appointment, location of appointment, and treatment/services to be received at appointment from referring source to the patient in a timely manner
  • Assists patients in problem solving potential issues related to financial or social barriers in completing the deemed necessary referral (e.g., request interpreter as appropriate, transportation services, etc.) Follow up with patients to ensure they have received the necessary care and address any issues or concerns.
  • Collaborate with healthcare providers and specialists to facilitate the referral process and ensure seamless care coordination.
  • Manages requests from third party referral sources and provides relevant information and data
  • Stay updated on insurance requirements, referral guidelines, and healthcare policies to ensure compliance with the referral process



Education and Training Requirements:

  • Certified Medical Assistant, (CMA), or Licensed Practical Nurse, (LPN), REQUIRED
  • Bachelor's degree in healthcare administration or related field is PREFERRED
  • Proven experience as a referral coordinator or in a similar role within a healthcare setting.
  • Knowledge of medical terminology, insurance procedures, and referral guidelines.
  • Strong organizational skills and attention to detail.
  • Excellent communication and people skills to effectively interact with patients, healthcare professionals, and insurance companies.
  • Ability to work independently and as part of a team in a fast-paced environment.
  • Proficiency in using electronic medical record (EMR) systems and other relevant software.
  • Understanding of HIPAA regulations and patient confidentiality.

Supervisory Responsibilities:

None

Work Environment:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The work is typically performed in an office environment, with a moderate noise level.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Movements including but not limited to prolonged periods of sitting at a desk and working on a computer, occasional standing, walking, bending, and reaching are required.
  • Specific vision abilities required by this job include close vision and color vision
  • Must be able to lift up to fifteen pounds

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