Medical Referral Coordinator

Medical Referral Coordinator

Status: Non-Exempt / Full Time / On Site

Medical Specialty: Womens Health - OB/GYN

Job Summary

The Medical Referral Coordinator is responsible for managing the complete lifecycle of patient referrals ensuring timely accurate and coordinated access to specialty care diagnostic testing and ancillary services. This position serves as the primary liaison between patients medical care providers specialists insurance companies and healthcare facilities to facilitate seamless continuity of care while maintaining compliance with organizational policies and all applicable federal and state regulations.

Essential Duties and Responsibilities

• Review provider orders medical records and clinical documentation to determine referral and diagnostic testing requirements.
• Process incoming and outgoing referrals ensuring all required clinical documentation laboratory results imaging reports and patient records accompany each referral.
• Collaborate with physicians advanced practice providers nurses and clinical staff to coordinate patient care and referral needs.
• Identify appropriate specialists facilities or ancillary service providers based on clinical necessity insurance participation and patient preferences.
• Verify patient insurance eligibility and benefits for specialty services and diagnostic procedures.
• Obtain prior authorizations pre-certifications referrals and other payer-required approvals before services are rendered.
• Coordinate and schedule specialist appointments diagnostic testing procedures and follow-up visits.
• Communicate appointment dates times locations preparation instructions and required documentation to patients.
• Educate patients regarding the referral process specialist expectations office policies and preparation requirements.
• Assist patients with barriers to care including transportation language interpretation services and coordination of community resources when appropriate.
• Maintain accurate referral documentation within the Electronic Health Record (EHR) and practice management systems.
• Monitor referral status to ensure appointments are completed and consultation reports diagnostic results and specialist recommendations are received and incorporated into the patients medical record.
• Follow up with specialty offices patients providers and insurance companies regarding incomplete referrals or outstanding documentation.
• Maintain ongoing communication with patients through appointment reminders referral updates and resolution of referral-related questions or concerns.
• Generate reports tracking referral volume turnaround times completion rates authorization status and referral outcomes.
• Provide regular updates to providers and leadership regarding referral trends operational issues and opportunities for process improvement.
• Participate in quality improvement initiatives designed to improve referral efficiency patient access and continuity of care.
• Maintain strict compliance with HIPAA OSHA CMS payer requirements and all applicable federal state and organizational policies.
• Safeguard patient confidentiality and protect all protected health information (PHI).
• Perform other duties as assigned.

Education and Experience

• High school diploma or GED.
• Minimum of one (1) year of experience in a medical office healthcare organization referral coordination scheduling patient access or related healthcare setting.

Preferred

• Associates degree or certification in Healthcare Administration Medical Assisting Health Information Management or a related healthcare field.
• Two (2) or more years of referral coordination or medical scheduling experience.
• Experience working with multiple insurance carriers and managed care organizations.

Knowledge Skills and Abilities

• Knowledge of medical terminology anatomy clinical procedures and healthcare workflows.
• Strong understanding of insurance verification referrals prior authorization and pre-certification processes.
• Proficiency with Electronic Medical Record (EMR) and Electronic Health Record (EHR) systems such as Epic Cerner eClinicalWorks Athenahealth or similar platforms.
• Proficient in Microsoft Office applications including Outlook Word Excel and Teams.
• Excellent organizational skills with the ability to manage a high volume of referrals while meeting deadlines.
• Strong attention to detail and commitment to documentation accuracy.
• Exceptional customer service and patient advocacy skills.
• Effective verbal and written communication with patients providers specialists and insurance representatives.
• Ability to prioritize multiple tasks in a fast-paced healthcare environment.
• Strong critical thinking and problem-solving skills.
• Ability to work independently while contributing effectively as part of a multidisciplinary healthcare team.
• Ability to maintain professionalism discretion and confidentiality at all times.

Physical Requirements

• Ability to sit or stand for prolonged periods throughout the workday.
• Ability to use a computer keyboard telephone and standard office equipment for extended periods.
• Ability to occasionally lift carry push or pull up to 50 pounds.
• Frequent walking reaching bending and occasional stooping.
• Ability to communicate clearly and effectively in person virtually and by telephone.

Work Environment

• Primarily performed in a medical office clinic or healthcare facility.
• Frequent interaction with patients healthcare providers insurance representatives and external specialty offices.
• Fast-paced environment requiring frequent multitasking attention to detail and adherence to established deadlines and regulatory requirements.

Core Competencies

• Patient-Centered Service
• Communication
• Organization and Time Management
• Collaboration and Teamwork
• Critical Thinking
• Attention to Detail
• Confidentiality and Professional Ethics
• Adaptability
• Accountability
• Continuous Quality Improvement

Benefits: (Waiting period may apply)

• 401(k) & Profit-Sharing
• Dental Insurance
• Disability Insurance
• Health Insurance
• Life Insurance
• PTO (Paid time off)
• Vision Insurance

Required Experience:

IC