Provider Referral & Benefits Coordinator

Coastal Communities Physician Network; Templeton (CA); On-site; USD 33,000 - 39,000; Full time

Job summary

Coastal-Communities-Physician-Network is seeking a Referral Coordinator to verify benefits and interpret coverage for health plans, including CMS procedures. You will coordinate with physician offices, clinics, and external providers to ensure smooth referral workflows and timely responses.

The role requires medical office experience, familiarity with ICD-10, CPT, HCPCS, and strong communication skills. Compliance with HIPAA and CMS timelines is essential, with attention to data accuracy and

Qualifications

• High School graduate or GED certification.
• One-year minimum experience in a medical office environment with prior authorizations required.
• Knowledge of medical terminology required.
• Knowledge of HCPC, CPT and ICD-10, required.
• Proficient written and oral communication skills.
• Demonstrate proficiency in computer systems utilized.
• Ability to remain organized and manage competing priorities.
• Demonstrate good judgement.
• Demonstrate ability to take and follow through with delegated tasks and accountability.
• Demonstrate resourcefulness in problem-solving.

Responsibilities

• Verify and interpret member benefits for health plans.
• Interact with other departments, clinic personnel, and outside providers to maintain positive relationships.
• Prepare authorizations and refer to providers/facilities and DME companies.
• Guide and communicate with physician offices and processing staff to ensure collaboration and timely responses.
• Review accuracy of pending referrals for ICD-10, CPT, HCPC codes and provider selections.
• Ensure referral data entry is accurate in UM systems.

Skills

Medical terminology

Computer skills

Prior authorization knowledge

Job description

Coastal-Communities-Physician-Network is seeking a Referral Coordinator to verify benefits and interpret coverage for health plans, including CMS procedures. You will coordinate with physician offices, clinics, and external providers to ensure smooth referral workflows and timely responses.

The role requires medical office experience, familiarity with ICD-10, CPT, HCPCS, and strong communication skills. Compliance with HIPAA and CMS timelines is essential, with attention to data accuracy and