Referral Coordinator

Company Description

Brandeis University, a medium-sized private research university located in Waltham, MA, is dedicated to providing first-rate education and making groundbreaking discoveries. Founded in 1948 as a nonsectarian institution, Brandeis welcomes talented students and faculty of every ethnicity, religion, and cultural background. The university's faculty are leaders in their fields, committed to teaching and mentorship, while the students are motivated, compassionate, curious, and open to new experiences.

Role Description

This is a full-time (35hrs per week) position. Serving as the primary liaison among patients, primary care providers, specialists, and insurance companies, the Referral Coordinator manages referrals and ensures that all follow-up reports and results are received and uploaded into the electronic medical record (EMR). Building and maintaining strong relationships with both internal and external referral sources will ensure a high-quality patient experience.

Other critical responsibilities include providing vital front-desk and billing support, including reception coverage, answering phones, greeting patients and visitors, scheduling appointments, and assisting with medical billing as needed while consistently adhering to all HIPAA & FERPA guidelines and organizational policies to protect patient confidentiality.

Key Responsibilities:

• Manage the full referral lifecycle: Efficiently process and track patient referrals from initial request to completion, ensuring timely appointments and follow-up. Coordinate with external providers by sending complete referral packets to specialists, including relevant clinical information, to prevent delays in care. Contact insurance carriers to verify patient eligibility, obtain prior authorizations, and ensure all requirements are met for specialized care.
• Patient communication: Inform patients about their referral status, scheduled appointments, and any necessary preparations. Address patient questions and concerns throughout the process. Track outstanding referrals by contacting patients and external providers to confirm appointment completion and request reports as needed. Obtain consultation reports, results, and images from external providers and ensure they are accurately uploaded into the patient's EMR for review by the referring provider. Systematically pursue missing or incomplete specialist reports and document all efforts in the patient's chart.
• Administrative Support: Serves as a back up to the front office staff during high-traffic times, staff shortages, or to manage overflow tasks such as answering phones, checking in patients as well as assisting with the health information review process.
• Maintain referral database: Keep an updated log or work queue of all external referrals, their statuses, and associated documentation. Investigate and resolve complex referral issues, including insurance denials, appointment conflicts, and barriers to patient access. Track and report on referral data, including the percentage of closed loops, to help improve clinical and operational performance.
• Billing: Assist with processing claims for ambulatory health, psychiatric, and counseling services through the practice management system and submission to the clearinghouse in a timely manner. Responsibilities include reviewing claims for coding accuracy and insurance requirements, returning claims needing correction to clinicians, assisting with insurance data corrections, and communicating diagnosis update needs based on denied claims. The role may also process payments, charge adjustments, and refunds in the practice management system; coordinates with Accounts Payable for posting of paper checks; prepares and distributes regular outcome reports; and serves as the site contact for clearinghouse communications while staying current on insurer claim submission requirements.

Qualifications

Minimum of an Associate degree highly preferred, Bachelor’s degree in administration/business or other similar fields preferred.

1-3 years related work experience

Strong organizational, communication skills and excellent interpersonal skills a must. Requires strong problem solving and customer relations skills and the ability to work independently at times.

Experience in a college health promotion, education, student affairs, or front office is a plus.

Ability to comprehend and communicate complex information in both verbal and written English. Competence with Google suite, and Microsoft Office. Required.

Competence with an Electronic Health Record and Health Insurance also required.