Referral Coordinator

Description

JOB SUMMARY

The Referrals Coordinator manages incoming and outgoing referrals for the General Surgery Department to ensure timely access to care and seamless coordination between referring providers, surgeons, and ancillary services. This role verifies referral requirements, obtains authorizations, schedules consultations, and ensures all necessary clinical documentation is secured prior to appointments or procedures. 

The Referrals Coordinator plays a vital role in supporting patient access, maintaining compliance with payer requirements, and promoting efficient workflow and high patient satisfaction. 

RESPONSIBILITIES

Referral Management & Coordination

• Receive, review, and process incoming referrals for general surgery consultations and procedures.
• Ensure referrals meet payer and clinical requirements prior to scheduling.
• Schedule patient consultations and communicate appointment details and instructions.
• Coordinate outgoing referrals to specialists, diagnostic services, and ancillary providers.
• Track referral status to ensure timely completion and follow-through.

Authorization & Insurance Verification

• Verify insurance eligibility and referral requirements.
• Obtain prior authorizations for consultations, diagnostic testing, and procedures as required.
• Communicate authorization requirements and status updates to patients and staff.
• Maintain accurate records of approvals, denials, and authorization expiration dates.

Documentation & Records Management

• Obtain and upload pertinent medical records, imaging, operative notes, and test results.
• Ensure referral documentation is complete and available prior to patient visits.
• Maintain accurate documentation within the electronic medical record (EMR).
• Protect patient confidentiality and comply with HIPAA regulations.

Communication & Patient Support

• Serve as liaison between referring providers, surgeons, clinical staff, and patients.
• Provide patients with clear instructions regarding appointments, required records, and next steps.
• Respond promptly to patient and provider inquiries regarding referral status.
• Facilitate continuity of care by ensuring follow-up recommendations are communicated.

Operational & Workflow Support

• Monitor referral work queues and prioritize urgent or time-sensitive cases.
• Assist with tracking referral metrics, turnaround times, and scheduling efficiency.
• Collaborate with scheduling, clinical, and authorization teams to optimize patient access.
• Identify workflow improvements to enhance referral processing efficiency. 

Requirements

QUALIFICATIONS

Education & Certification

• High school diploma or equivalent required.
• Medical office certification or healthcare-related training is preferred.

Experience

• Minimum 2 years of experience in a medical office, surgical practice, or referral coordination role preferred.
• Experience with insurance verification and prior authorizations is strongly preferred.

Knowledge & Skills

• Knowledge of medical terminology and referral processes.
• Understanding of insurance requirements, authorizations, and payer guidelines.
• Strong organizational and multitasking skills.
• Excellent communication and customer service abilities.
• Proficiency with electronic medical records and scheduling systems.
• Ability to manage multiple priorities in a fast-paced clinical environment.

Physical Requirements

• Prolonged sitting and computer use.
• Occasional standing, walking, and assisting with patient flow.
• Ability to lift up to 20 pounds as needed.