Referral Coordinator

Chase Brexton Health Care; Columbia (MD); On-site; USD 36,000 - 52,000; Full time

Job summary

Chase Brexton Health Care is seeking a Referral Coordinator to support the care team by processing referrals for specialty consults, obtaining prior authorizations, and ensuring timely documentation in the EMR.

The role emphasizes insurance verification, scheduling urgent referrals within 24 hours, tracking outstanding steps, and maintaining patient confidentiality while communicating clearly with the care team and patients.

Qualifications

• High school diploma or GED required.
• At least 1 year of customer service experience.
• Experience in a medical office and with EMR systems preferred.
• Knowledge of HIPAA and PHI required.

Responsibilities

• Process and track routine and urgent referrals with care team.
• Verify insurance prior to completing referrals.
• Assist with scheduling urgent referral appointments.
• Complete non-urgent referrals within defined timeframes.
• Document consult notes/reports in the EMR within one month of visits.
• Maintain confidentiality and follow privacy laws.

Skills

Medical terminology

HIPAA/PHI knowledge

EMR CPS12 literacy

Time management

Verbal and written communication

Teamwork

Confidentiality

Multitasking

Independent work

Problem solving

Education

High school diploma or GED

1 year customer service experience

Medical office experience

EMR experience

Job description

Job Summary

The Referral Coordinator works with the care team to process and track routine and urgent referrals to facilitate the process for specialty consults, follow up care, and prior authorization when necessary. Makes appropriate referrals to or for other services and resources available (e.g., medical, dental, etc.).

Major Duties and Responsibilities

Checking, Examining, and Recording

• Verifies insurance prior to completing referrals.
• Completes urgent referrals within 24 hours as requested.
• Assists with scheduling urgent referral appointments with the referred specialist.
• Completes non‑urgent referrals within 5 business days.
• Ensures that referrals have a consult note/report documented within one month of the visit and contacts responsible party if a consult note/report is missing within one month of the visit.

Analytical and Critical Thinking

• Obtains prior authorization when required by insurance carrier.
• Participates in services audits as instructed by supervisor.
• Responsible for referral tracking and documenting outstanding steps in the process before the order can be marked complete in the EMR.
• Ensures transition of care is completed for providers.
• Carries out various quality assurance activities, such as gathering client feedback regarding problems with access or quality of services and communicating findings to relevant entities.

Communication

• Clearly and effectively interacts with members of the care team to communicate information.
• Reads and responds to voicemail, EPR, and e‑mail several times daily.
• Assures timely follow‑up and communication.
• Documents in EMR the steps taken to complete referrals and prior authorizations have been completed timely and thoroughly.
• Notifies patient of referral details.

Patient Focus

• Identifies patient needs and issues and works to resolve problems while advocating for the patient.
• Demonstrates a desire to understand patient’s needs and how the organization can meet those needs.

Workplace Computers and Equipment

• Handles telephone and written inquiries.
• Enters information into Patient Management System and EMR.
• Detects and corrects errors, completes forms, obtains needed information, and maintains logs and files.
• Enters referral information into EMR utilizing appropriate insurance panel.
• Fax referral and supporting documentation to specialist office in advance of the scheduled appointment.
• Responsible for marking referrals complete in the EMR after the required outside medical documentation is received.

Compliance, Policy, and Procedure

• Maintains patient confidentiality.
• Complies with federal and local patient privacy laws.
• Verifies patient and/or guardian identification.
• Documents services by initiating appropriate forms, entering client data into the EMR and ensuring all documentation is appropriately signed and dated.
• Provides ideas and suggestions when opportunities for improvement present in existing services based on interactions.

Teamwork

• Maintains open relationships and lines of communication with co‑workers.
• Works with a multidisciplinary team to establish rapport and improve patient outcomes.

Skills and Abilities

• Some medical terminology.
• Basic understanding of HIPAA and PHI.
• Basic navigational knowledge of electronic medical record applications such as CPS12.
• Must have excellent time management skills, be organized, and self‑motivated.
• Possesses excellent written, verbal, and interpersonal communication skills.
• Maintains a high level of productivity and confidentiality.
• Works well in a team environment.
• Can enter data accurately and verify spelling of names, numbers, dates and times.
• Handles multiple tasks at once without mistakes or diminution of professional demeanor and customer service.
• Effectively prioritizes and maintains workflow.
• Functions in a high volume, multiple task environment, possibly in a closely shared workspace.
• Demonstrates self‑motivation and the ability to work independently.
• Effectively and efficiently solves problems as presented in real time.
• Strong organizational and task prioritization skills.

Education and/or Experience

• Required: High school, G.E.D. or equivalent.
• Required: One year of customer service experience.
• Desired: One (1) year experience in a medical office environment.
• Experience with Electronic Medical Records Systems.