Referral Coordinator (CC26159 - NIC)

CommuniCare Health Center Careers; Georgia; On-site; USD 32,000 - 42,000; Full time

Job summary

CommuniCare Health Center Careers in the United States (Georgia) is seeking a patient services coordinator to manage appointment scheduling, referrals, and insurance verification within the EHR system. The role emphasizes high-quality customer service, HIPAA-compliant handling of patient information, and collaboration with providers and staff.

The ideal candidate has a high school diploma, experience in healthcare-related customer service, and proficiency with EMR/EHR systems and Microsoft

Qualifications

• High School graduate or equivalent is required.
• Medical referral experience preferred.
• Experience in customer service, preferably in a healthcare setting.
• Experience with EMR/EHR and medical terminology preferred.
• Excellent oral and written communication and interpersonal skills.
• Experience with insurance verification and healthcare billing preferred.
• Proficient with Microsoft Word, Excel and Outlook.

Responsibilities

• Schedules patient appointments using provider templates and ensures patient demographics and insurance info are current in the EHR.
• Provides telephone etiquette and courteous service; supports process improvements in call flow.
• Follows HIPAA privacy policies and reports potential breaches.
• Processes referrals by oldest date and urgency; tracks progress to avoid backlog.
• Coordinates between patient, PCP and specialty provider for scheduling and issues updates as needed.
• Notifies patients of incomplete processing and provides clear next steps.
• Delivers excellent internal/external customer service via phone, messaging, and fax.
• Performs other related duties as assigned.

Skills

Customer service

Oral and written communication

Insurance verification

Bilingual English/Spanish

Education

High School/GED in General Business

Job description

Responsible for answering telephones, scheduling appointments and providing exemplary customer service. Processes referrals for Adult Medicine, Pediatric, Medical Specialty and Behavioral Health providers. Performs verification of insurance coverage and benefits, and obtains authorization for treatment as required by insurance plan, according to third party payer guidelines. Documents referral/authorization information and communication in Electronic Health Record (EHR) system.

DUTIES AND RESPONSIBILITIES:

1. Schedules patient appointments utilizing established provider templates. Ensures patient demographics and insurance information in the EHR is complete, accurate and up to date. Works cohesively and interdepartmentally with providers and support staff to optimize templates; performs patient schedule changes as needed. Documents and relays information with external providers as appropriate to facilitate patient care.

2. Demonstrates appropriate telephone etiquette according to the policies and procedures of the department, and provides prompt and courteous service upon each telephone call received. Proactively participates in the implementation of new initiatives and processes. Suggests improvements in call flow processes and communication as needed; participates in organized efforts to continuously improve service excellence levels.

3. Follows the Center’s policies and procedures pertaining to patient privacy and protected health information. Reports any potential breach of privacy, HIPAA violation or suspicious behavior or activity relating to patient health records to supervisor or other appropriate chain of command.

4. Processes referrals according to the oldest date ordered and level of urgency, tracks and manages referrals throughout every stage to avoid backlog and ensure completion, and maintains consistent channel of communication between staff, providers and patients.

5. Coordinates between patient, PCP and specialty provider for appointment scheduling; informs provider and/or supervisor of unusual delay, insurance issue or other problem with completing referral in a timely manner.

6. Notifies patient of reasoning for incomplete processing and provides feedback for referral via messaging system or telephone call; provides additional instructions as needed.

7. Provides excellent internal/external customer service via telephone, messaging system and fax contact to assist patients with their healthcare needs.

8. Performs other related duties as assigned.

JOB QUALIFICATIONS:

High School graduate or equivalent required

Medical referral experience preferred

Minimum of one year of experience in customer service, preferably in a healthcare setting

Experience with EMR/EHR and medical terminology preferred

Excellent oral and written communication and interpersonal skills

Experience with insurance verification and healthcare billing preferred

Proficient in the use of personal computers, including Microsoft Word, Excel and Outlook

Ability to handle multiple tasks efficiently with minimal supervision

Bilingual in English and Spanish preferred

Scheduled hours and/or work locations are subject to change

PHYSICAL ACTIVITIES AND REQUIREMENTS:

Finger Dexterity: Using fingers to make small movements such as typing or picking up small objects.

Talking: Frequently conveying detailed or important instructions or ideas accurately, clearly, or quickly.

Hearing: Able to hear average or normal conversations and receive ordinary information.

Repetitive Motions: Frequently and regularly using the wrists, hands, and fingers.

Visual: Average, ordinary, visual acuity necessary to prepare or inspect documents or other materials.

Physical: Physical work involving bending, stooping, standing most of the time. May have to lift folders, files, papers, equipment, and other such items weighing up to approximately 25 lbs. Ability to sit for long periods.

Qualifications

Skills

Behaviors

Motivations

Education

Required

High School/GED or better in General Business.

Experience

Licenses & Certifications

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.