Referrals Coordinator

Franciscan Medical Group; Washington (District of Columbia); On-site; USD 52,000 - 72,000; Full time

Job summary

Virginia Mason Franciscan Health is seeking a Referral Specialist to orchestrate patient access by managing referral and authorization processes. You will obtain clearances for specialty visits, issue referrals for ancillary services, and secure approvals for medications and DME.

The role requires meticulous attention to detail, strong organizational and communication skills to ensure seamless service delivery for our patients.

Qualifications

• Successful completion of an accredited medical terminology course(s) or equivalent on the job training, upon hire
• One year of progressively responsible work experience in a related role
• None, upon hire

Responsibilities

• Process referral orders and/or pre-authorizations.
• Ensure insurance eligibility checks are conducted before the patient is seen by escalating to the Insurance Verifier or by direct eligibility checks.
• Complete referrals and/or pre-authorizations for diagnostic testing, therapy, surgeries, procedures and specialty care.
• Provide information to patients regarding their health care plan and communicate plan policies.
• Answer billing and insurance questions and obtain a cost estimate when requested.
• Notify physician and patient if a referral is denied or needs additional information.
• Update the patient’s medical record in the EMR.
• Coordinate appointments and ancillary services according to authorized referrals.

Skills

Attention to detail

Strong organizational skills

Clear communication

Customer service

Education

Medical terminology course

Tools

Electronic Medical Record (EMR) system

Insurance verification tools

Job description

Job Summary and Responsibilities

As our Referral Specialist, you will orchestrate patient access to specialized care by expertly managing all referral and authorization processes.

Every day, you will proactively obtain clearances for specialty visits, issue referrals for ancillary services (consults, imaging, labs), and secure approvals for medications, DME, home health, and other vital services.

To be successful in this role, you will demonstrate meticulous attention to detail, strong organizational skills, and clear communication to ensure seamless and efficient service delivery for our patients.

• Processes referral orders and/or pre-authorizations.
  • Ensures that insurance eligibility checks have been conducted on all referrals before the patient is seen, either by escalating to the Insurance Verifier, or by directly checking on eligibility.
  • Completes referrals and/or pre-authorization, before the patient is seen, for diagnostic testing, therapy, surgeries, procedures and specialty care according to requirements and patient preference.
  • Provides information to patients regarding their health care plan; interprets and communicates plan policies and procedures to employees, physicians and members (patients).
  • Provides patients with answers to billing and insurance clarification questions; obtains a cost estimate when requested and explains insurance benefit coverage to patient.
  • Notifies physician(s) and patient when referral is denied or if a second opinion or additional info is needed.
  • Updates the patient’s medical record as necessary. Copies/scans documents into correct location within electronic medical record.
  • May interact with referring clinic to ensure successful coordination of patient care.
• Coordinates appointments and ancillary services.
  • Coordinates patient clinic visits based on authorized referral in accordance with established standards and procedures; gathers and documents insurance eligibility data, conducting routine verifications that can be done quickly during conversation; enters data in patient’s electronic medical record as appropriate.
  • Identifies patients requiring contact to confirm a referral appointment; contacts patient in accordance with established procedures.
  • Contacts and follows up with patients to reschedule a missed/cancelled appointment; documents reason(s) for no-show in accordance with established procedures; notifies management if patient has violated a policy and further action is required.
• Responds to patient questions regarding routine billing and insurance matters.
  • Provides basic information in response to patient questions on billing and insurance matters; obtains a non-complex cost estimate when requested; refers questions regarding more complex cost estimates/benefits information to Financial Counselor.
• Coordinates patient instructional/educational activities relevant to the patient’s referral.
  • Works with clinic team, patients and/or employers to ensure that patients receive adequate instructions and information regarding educational opportunities relevant to the patient’s referral; provides information to patients regarding their referral appointment and service for testing, financial policies, registration requirements, etc.
  • Provides patient with pre-visit prep materials; packages materials to correspond with type/nature of patient appointment and sends to patient in a timely manner.
• Coordinates purchase of materials and/or the rental of medical equipment relevant to the patient’s referral.
  • Follows up with patients when equipment return is due.

Job Requirements

Required

• Successful completion of an accredited medical terminology course(s) or equivalent on the job training, upon hire and
• one year of progressively responsible work experience that would demonstrate attainment of the requisite job knowledge/abilities. and
• None, upon hire

Preferred

• Work experience in patient scheduling/registration, insurance verification, referral coordination, financial counseling or related function

Where You'll Work

Virginia Mason Franciscan Health has a rich history of providing exceptional healthcare, dating back to 1891. Building upon a legacy of compassionate care and innovation, our organization has evolved over the years through strategic partnerships and integrations to expand our reach and services across the Puget Sound area.

Today, as Virginia Mason Franciscan Health, we remain deeply committed to healing the whole person - body, mind, and spirit - in the communities we serve. This commitment is strengthened by the diverse expertise and shared values brought together through our growth.

Our dedicated providers offer a full spectrum of health care services, from routine wellness to complex disease management, all grounded in rigorous research and education. Our comprehensive network of 10 hospitals and nearly 300 care sites strategically located across the greater Puget Sound region reflects our ongoing commitment to accessibility and comprehensive care.

We are proud of our pioneering medical advances and numerous awards and accreditations that reflect our dedication to excellence. When you join Virginia Mason Franciscan Health, you become part of a team that delivers top-quality, professional healthcare in modern, well-equipped facilities, and contributes to a legacy of service built on collaboration and shared purpose.