Referral Coordinator

Description

Job Summary: The Referral Coordinator is responsible for overseeing and managing the patient referral process. This role ensures timely, accurate, and efficient coordination between physicians, specialists, and other healthcare providers. The Referral Coordinator serves as a key communication link among patients, healthcare professionals, and insurance companies to support optimal patient care and smooth transitions between healthcare services.

Supervisory Responsibilities: N/A

Essential Duties / Responsibilities:

• Handle incoming and outgoing phone calls with patients.
• Manage the complete referral process, including receiving, processing, and tracking referrals from initiation to completion. 
• Coordinate with physicians and healthcare providers to obtain all required documentation and information.
• Provide timely updates on referral status to patients, healthcare providers, and other relevant parties.
• Verify insurance eligibility and secure necessary pre-authorizations as needed for referrals.
• Schedule patient appointments once authorization is confirmed.
• Register patients and create cases in the healthcare system, ensuring accurate and thorough documentation.
• Confirm patient consent and willingness to proceed before submitting authorizations.
• Maintain accurate, up-to-date records of referrals, patient data, and related communications.
• Educate patients about the referral process, including insurance requirements and potential financial obligations.
• Collaborate with clinical and administrative teams to resolve referral or patient care issues.
• Track and report referral metrics and key performance indicators to identify trends and opportunities for improvement.
• Provide support and training assistance to team when needed
• Communicate with insurance companies for timely pre-authorizations.
• Assist with billing inquiries and issues related to referrals.
• Coordinate care transitions with patient care teams to ensure continuity of services.
• Review and assess referral workflows regularly to enhance efficiency.
• Uphold patient confidentiality and comply with all HIPAA regulations.
• Participate in quality improvement initiatives related to referral management.
• Other duties as assigned.

Required Skills / Abilities:

• Positive and professional demeanor
• Strong conflict resolution and problem-solving skills
• Collaborative team player focused on achieving optimal outcomes
• Excellent verbal and written communication skills across multiple channels
• Thorough understanding of insurance coverage and policy requirements
• Self-motivated with the ability to work independently
• Flexible and adaptable; able to multitask effectively in a fast-paced environment
• Perform well under pressure and manages time efficiently
• High attention to detail and accuracy
• Reliable and dependable work ethic
• Open to feedback and demonstrates growth from constructive input
• Proficient in Microsoft Office applications
• Maintains strict compliance with HIPAA regulations

Education and Experience:

• High School Diploma or GED required
• Additional education or training in healthcare administration or related fields are preferred.
• Proven experience in a healthcare setting, preferably in referral coordination or related administrative roles.
• Experience with insurance verification and pre-authorization processes (preferred).

*StrideCare is an Equal Opportunity Employer and is committed to diversity and inclusion in our workforce. We encourage applications from candidates of all backgrounds and experiences.

Requirements

• Ability to sit for extended periods while working on a computer.
• Manual dexterity to operate standard office equipment, including computers, phones, and fax machines.
• Ability to occasionally lift and carry items weighing up to 20 pounds.
• Sufficient visual acuity to perform tasks involving computer screens and paper documents.
• Ability to move throughout the office to access files, equipment, and other necessary resources.
• Home office requirements: Maintain a dedicated workspace that is professional, organized, and free from distractions.
• Have a reliable high-speed internet connection capable of supporting voice calls, data entry, and system usage without interruption.
• Ensure workspace security and confidentiality, adhering to company policies on data protection and HIPAA privacy standards.