Referral Coordinator

Job Summary

The Referral Coordinator serves as a key member of the Patient Advocacy Team (PAT) by coordinating specialty referrals, insurance authorizations, and continuity of care services for HAPPI Health patients. This role acts as a liaison between patients, providers, specialists, hospitals, and insurance companies to ensure patients receive timely access to recommended healthcare services.

The Referral Coordinator is responsible for managing referral workflows from initiation through completion, maintaining accurate documentation within the electronic health record, communicating referral updates to patients and providers, and collaborating with multidisciplinary teams to reduce barriers to care. This position plays a vital role in supporting patient-centered care through effective communication, organization, and care coordination.

Essential Job Responsibilities

• Coordinate specialty referrals from provider order through referral completion.
• Review referral orders for accuracy and ensure all required documentation is obtained prior to submission.
• Submit insurance referrals and authorizations in accordance with payer guidelines, including Medicaid, Medicare, Tricare, BCBS, UnitedHealthcare, and other commercial insurance plans.
• Maintain accurate referral documentation within the electronic health record (Athenahealth).
• Communicate referral status and next steps to patients, providers, and specialty offices.
• Respond to incoming calls, portal messages, and referral correspondence in a timely and professional manner.
• Monitor referral work queues and follow up on pending referrals, incomplete documentation, and outstanding patient care needs.
• Review consult notes and attach clinical documentation to the appropriate referral orders.
• Coordinate hospital and emergency room follow-up activities as assigned.
• Collaborate with providers, nursing staff, medical assistants, clinical support staff, and external healthcare partners to promote continuity of care.
• Identify and resolve barriers that may delay patient access to specialty care.
• Maintain compliance with organizational policies, payer requirements, HIPAA regulations, and applicable healthcare standards.
• Participate in departmental process improvement initiatives and workflow development.

Key Skills & Qualifications

• Strong understanding of referral coordination and continuity of care within a healthcare setting.
• Working knowledge of medical insurance plans, payer guidelines, and referral/authorization requirements.
• Proficiency with electronic medical record (EMR/EHR) systems; Athenahealth experience preferred.
• Excellent organizational and time management skills with the ability to prioritize multiple tasks in a fast-paced environment.
• Strong written and verbal communication skills with the ability to communicate effectively with patients, providers, specialists, and insurance representatives.
• Ability to review documentation for completeness and identify missing information that may delay patient care.
• Strong problem-solving and critical thinking skills with the ability to resolve referral barriers and coordinate appropriate follow-up.
• Ability to work independently while collaborating effectively within a multidisciplinary healthcare team.
• Proficiency in Microsoft Office Suite (Outlook, Word, Excel) and general computer applications.
• Commitment to providing exceptional customer service with a patient-centered approach.
• Ability to maintain patient confidentiality and comply with HIPAA regulations.

Qualifications

• Licensed Practical Nurse or Certified Medical Assistant Required
• Previous experience in a referral coordination or care coordination role, preferably within a federally qualified healthcare center.
• Knowledge of healthcare systems, insurance processes, and referral management.
• Strong communication skills, both verbal and written, with the ability to communicate effectively with patients, providers, and other staff.
• Ability to work independently and as part of a multidisciplinary team.
• Proficiency in using Electronic Health Record (EHR) systems and other relevant healthcare software.
• Familiarity with the specific needs and populations served by Federally Qualified Healthcare Centers is preferred.
• Bilingual skills (e.g., Spanish) are a plus.
• Athena experience preferred.

Work Environment

• This position operates in a healthcare clinic environment with moderate noise levels and potential exposure to patients with infectious conditions.
• Flexibility in work schedule may be required based on the needs of the healthcare center.