Referral Coordinator

Job purpose 

The Referral Coordinator manages the patient referral and insurance authorization process, ensuring patients receive timely access to specialized care. This role coordinates with providers and insurance companies to obtain necessary approvals and tracks referral completion. The position aims to streamline communication and provide excellent customer service, ensuring efficient, patient-centered care. 

Duties and responsibilities 

• Receive and process incoming authorizations, received on paper, phone, or electronically. 

• Organize referrals for patients to external specialists and prepare referral forms, transmitting necessary information to specialists. 

• Submit referral data to insurance companies for approval and authorization. 

• Communicate with providers to obtain additional or missing clinical documentation for medical review. 

• Manage appeals and coordinate with providers to determine next steps. 

• Work with providers and specialists to schedule urgent referrals for patients as necessary. 

• Monitor the status of referrals. Call patients or external agencies as needed and coordinate with professional staff to follow up and track referral completion. 

• Complete prior authorizations for procedures and tests requiring insurance approval, gathering necessary clinical information from providers or care team. 

• Perform eligibility checks for members through phone or electronic means as required. 

• Provide excellent customer service to both internal and external customers regarding pending authorizations and other related issues. 

• Complete other related duties and projects as assigned. 

Qualifications 

Education & Experience: 

• High School Diploma or equivalent combination of relevant experience and education  

• 2 year or more of work-related experience. 

Knowledge, Skills, & Abilities: 

• Familiarity with healthcare workflows, insurance processes, and referral systems to ensure efficient management of patient referrals and authorizations. 

• Knowledge of insurance policies, authorization processes, and eligibility verification to manage patient referrals and claims. 

• Ability to accurately process referrals, review documentation, and ensure all necessary information is captured without errors. 

• High level verbal and written communication skills. 

• Understanding of common medical terms and procedures. 

• Ability to manage multiple tasks, track referral statuses, and follow up with various parties in a timely and organized manner. 

• Ability to handle appeals, resolve authorization issues, and find solutions to referral delays or challenges. 

• Ability to adapt to changing processes, technologies, and patient needs. 

• Proficient in Epic to manage referrals, track authorization statuses, obtain insurance approvals, and communicate effectively with healthcare teams. 

• Verbal and written fluency in English required; Bilingual skills in a second language (particularly Spanish, Mandarin, Vietnamese) desired but not required. 

Competencies:   

• Ability to communicate well with people of diverse cultural professional and experiential background  

• Ability to establish and maintain effective work relationships as part of a multi-disciplinary team.  

Working conditions 

Work is conducted in a standard office environment. Occasional evenings and weekend work is required. 

Physical requirements 

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.  

While performing the duties of this job, the employee is required to talk and hear.  The employee is required to sit for extended periods of time, see to utilize a computer screen, frequently use hands; and reach with hands and arms for activities such as keyboarding. The mental demands of the job include regular comprehension, reasoning and decision making, organizing, reading, and writing. 

AACI is an Equal Opportunity Employer.