Lead Referral Coordinator

The Lead Referral Coordinator provides clerical and administrative support to the health center for the organization of internal and external referrals. This position will support the daily needs of all Referral Coordination for the clinical departments in the health center. The Lead Referral Coordinator is responsible for communication to ensure that all appointments, required documentation, insurance information and prior authorizations are established with specialty providers, insurance entities and patients for his/her caseload.

Essential Functions:

• Ensures proper referral processes are followed by the Referral Center Team.
• Monitors staff workload and productivity to maintain both quality and efficiency.
• Serves as a consultant to staff, providing guidance and support with problem-solving.
• Reviews referral requests from providers and communicates with them or the patient’s care team as needed for clarification.
• Obtains prior authorizations for referrals to specialists and surgeries; notifies providers of any denials.
• Coordinates with insurance companies to process referrals accurately.
• Verifies patient insurance eligibility.
• Communicates referral status to patients.
• Requests consult notes after specialist visits and closes referrals upon receipt.
• Maintains communication with specialists regarding referral needs and follow-ups.
• Tracks and processes referrals in NextGen Diagnostics and the Referrals section of the SOAP note.
• Prioritizes referrals based on urgency or PCP request.
• Maintains up-to-date knowledge of referral resources, required forms, and key contacts.
• Tracks referral data for quality assurance programs.
• Ensures compliance with all applicable state and federal regulations, including HIPAA, OSHA, Scope of Practice, and sexual harassment policies.
• At all times demonstrates cooperative behavior with supervisors, clients, colleagues and the community.
• Participate in internal quality improvement teams.  Works with team members proactively to drive quality improvement initiatives in accordance with the mission and strategic goals for the organization, federal and state laws and regulations, and accreditation standards.
• Performs other duties as assigned.

Skills and Abilities

• Knowledge of Medical Terminology and Insurance Processes: Familiarity with referral procedures, prior authorizations, and payer requirements.
• Technical Proficiency: Skilled in using electronic health record (EHR) systems (e.g., NextGen) and other referral tracking tools.
• Problem-Solving and Critical Thinking: Ability to assess issues, identify solutions, and support staff in resolving challenges.
• Time Management and Multitasking: Effectively prioritizes competing demands while maintaining accuracy and compliance.

Core Competencies

• Referral and Insurance Coordination: Expertise in referral workflows, prior authorizations, and insurance requirements.
• Communication and Customer Service: Builds effective relationships with patients, providers, specialists, and insurers.
• Leadership and Team Support: Guides referral staff, ensures workflow consistency, and assists with problem-solving.
• Organization and Attention to Detail:   Prioritizes tasks, maintains accurate records, and ensures timely follow-up.

Minimum Qualifications:

• High School diploma or equivalent
• Two years of experience in medical referrals or other related medical patient support functions in a clinical setting
• Knowledge of medical terminology and medical procedure terminology
• Knowledge of Medi-Cal and Medicare insurance payers, eligibility process, and authorization for services
• Electronic Health Record (EHR) experience required

Preferred Qualifications

• One year of experience in a lead or supervisory role in a clinical setting
• Prior experience with NextGen EHR/EDR software
• Knowledge of programs, services, and resources available to patients in the Sacramento and surrounding areas
• Bilingual or multilingual skills (e.g., Spanish, Russian, Hmong, etc.)
• Associate’s degree or higher in healthcare administration, medical assisting, or related field

Salary : $24 - $26