Referral Coordinator

Providence Community Health Centers; Providence (RI); Hybrid; USD 42,000 - 58,000; Full time

Job summary

Providence Community Health Centers seeks a Referral Coordinator to streamline referrals, authorizations, and scheduling across physicians, nurse case managers, and community specialists. You will navigate insurance requirements, coordinate with care teams, and ensure timely processing of referrals and related documents.

The role emphasizes collaboration, accuracy, and HIPAA compliance, with experience in ambulatory care settings preferred.

Qualifications

• Excellent oral and written communication with care teams.

Responsibilities

• Process referrals and prior authorization requests from multiple providers.

Skills

Communication

Independence

Microsoft Office

Medical Terminology

EHR Experience

Scheduling System

HIPAA Knowledge

Diversity Awareness

Transport Access

Background Check

Prior Authorizations

Education

Associate degree

Tools

Scheduling System

EHR System

Job description

A Referral Coordinator works collaboratively with physicians, practitioners, counsellors, nurse case managers and other departments to coordinate transfer of care between PCHC providers and community specialists. This person functions as the problem solver for their clinical team 1 assisting with administrative duties such as completing and expediting referrals, medication prior authorization from different insurance companies, assisting with completion of routine forms, and other logistical duties.

Duties & Responsibilities:

• Monitors the electronic health record to receive and process requests for referrals and diagnostic imaging prior authorizations during standard clinical hours. Able to prioritize and successfully process referrals and related forms from multiple providers.
• Proactively reviews new referrals and diagnostic imaging prior-authorization requests for completeness and accuracy. Able to interpret standard insurance guidelines to identify incomplete referrals before processing, and communicates directly with the care team regarding any necessary testing or records required for approval.
• Has a clear understanding of insurance plans, with knowledge of covered services and community specialists within the insurance company b9s network.
• Functions as a liaison between insurance companies and care teams for high risk referrals and diagnostic imaging requests. Accesses insurance companies web-based program(s) to check the status of pending prior authorizations. Escalates all unresolved high risk referral issues back to the care team in a timely manner.

Qualifications:

• Excellent oral and written communication skills and the ability to effectively communicate medical and behavioral health conditions to community specialists.
• Ability to work independently and as part of a health care team.
• Basic knowledge/experience in navigating web based portals required, as well as, Microsoft Office products such as Excel, Word, and Outlook.
• Medical Terminology required.
• Proficiency in use of the PCHC electronic health record and scheduling system, preferred.
• Ability to develop positive relationships with community specialists and insurance carriers.
• Experience with processing prior authorizations and referrals, preferred.
• Knowledge of state and federal health care programs, including Medicaid, Medicare and other public benefits programs, preferred.
• Knowledge of HIPAA regulations and ability to maintain strict confidentiality of patient health information at all times.
• Experience working with the under-served and uninsured populations.
• Access to reliable transportation.
• Background check/Life Links access required.
• Ability to communicate with people of various diverse backgrounds in a sensitive and compassionate way.

Education:

• Minimum of an Associate b4s Degree and/or completion of a medical training program.
• Prior experience working in an ambulatory care center.