Referral Coordinator

CommUnityCare; United States; Remote; USD 42,000 - 56,000; Full time

Job summary

CommUnityCare is seeking a Referral Coordinator to manage the patient referral process across clinics. You will coordinate referrals, schedule appointments, and ensure timely documentation in the EPIC system, while upholding accreditation standards and department SOPs.

The role emphasizes strong communication with patients, staff, and insurance carriers, plus adherence to regulatory guidelines and continuous quality improvement efforts within a community healthcare setting.

Qualifications

• Ability to build relationships with patients and staff while delivering accurate information.
• Strong attention to detail and accuracy in records and referrals.
• Proficient data entry and use of computer systems for scheduling and documentation.
• Excellent verbal and written communication and customer service skills.
• Knowledge of federal, state, and local insurance regulations and referral processes.

Responsibilities

• Coordinate patient referrals across departments and ensure timely processing.
• Schedule appointments according to clinic guidelines and capacity.
• Audit referral records and maintain up-to-date information in the system.
• Obtain referral authorizations from insurance carriers and relay decisions to patients and providers.
• Resolve pre-authorization, registration, or referral issues before appointments.
• Communicate with patients per protocol and keep referral resources current.
• Ensure referrals comply with SOPs and meet patient access needs.
• Document in EPIC and maintain accurate patient records.
• Attend team meetings and pursue continuing education and best practices.

Skills

Customer service

Attention to detail

Data entry

Verbal and written communication

Insurance regulations knowledge

Team collaboration

Education

High School Diploma or equivalent

Job description

Overview

In collaboration with patients, families (as defined by the patient) and staff across all disciplines and departments is responsible for coordinating all aspects of the patient referral process in a community healthcare center setting and for adhering to established timelines and departmental procedures.

Responsibilities

DUTIES AND RESPONSIBILITIES:

• Monitors templates for appointment availability
• Assists in the expansion of the referral department through the orientation and training of new team members under the direction of the Triage and Referral Nurse Manager
• Schedules appointments per clinic guidelines as appropriate
• Conducts auditing of records for the referral team as needed
• Gathers pertinent information from insurance carriers, financial counselors, or other staff regarding appointments to determine financial responsibility
• Obtains referral authorization from insurance carriers for specialty services and relay such authorizations (or denials) to the patient and provider
• Resolves pre-authorization, registration, or other referral related issues prior to a patient's appointment
• Contacts patients verbally or in writing per current protocol
• Maintains updated referral resources
• Upholds and completes referrals ensuring that the entire referral process is complete
• Ensures referral Standard Operating Procedures are followed for all referrals
• Ensures referral requests received from the PCP are addressed in a timely fashion
• Ensures that all documentation is completed in EPIC
• Ensures referrals are completed in an appropriate timeframe to meet patient needs for access to services
• Completes all direct and indirect care documentation in timely manner and ensure patient records are current and complete
• Attends team huddles and scheduled meetings
• Attends seminars and maintain all licensure and/or certification requirements for continuing education and best practices
• Participates in quality strategies to evaluate compliance with evidence-based guidelines/standards and to identify opportunities to improve patient outcomes
• Ensures all tasks provided and associated with patient care, patient administrative processes, and related duties comply with all regulatory and accreditation standards including The Joint Commission and CommUnityCare Standard Operating Procedures and CommUnityCare Policies and Procedures
• Develops and maintain favorable internal relationships, partnerships with co-workers, including clinical managers, clinical support staff, providers, and business office staff
• Interacts respectfully and collaboratively with patients and their families, striving to develop favorable relationships with families
• Collaborates with all members of the care team in providing patient-centered care
• Meet defined productivity standards
• Performs other duties as assigned

KNOWLEDGE/SKILS/ABILITIES:

• Demonstrates a high level of skill at building relationships and providing excellent customer service
• Inhibits a strong attention to detail and accuracy
• Has the ability to utilize computers for data entry and information retrieval
• Shows excellent verbal and written communication skills
• Demonstrates knowledge of federal, state, and local insurance regulations
• Demonstrates knowledge of the referral process for a variety of insurance plans
• Demonstrates success in researching and resolving complex issues
• Demonstrates familiarity and proper care of electronic devices common GUIs found within most health care environments (for example, personal computer skills, spreadsheets, word processing, patient record systems, EHR systems, etc…)

Qualifications

MINIMUM EDUCATION: High School Diploma or equivalent

MINIMUM EXPERIENCE:

• Three years' experience in the healthcare field including one year experience as a Medical Assistant, Medical Administrative Clerk, Patient Services Representative, or Dental Assistant