Referral Coordinator

Description

Position Summary

The Referral Coordinator manages inbound and outbound referrals across CFHC, CBHW, and CSA to support timely access to care and continuity between referring and receiving providers. This position works closely with providers, registration staff, medical assistants (MAs), patients, and external offices to obtain complete referral information, coordinate referral-related insurance requirements and scheduling, monitor progress, and ensure consultation reports are received and routed to the appropriate provider. The Referral Coordinator reports to the Patient Access Supervisor and escalates clinical questions and urgency concerns to the appropriate clinical team.

Essential Duties and Responsibilities

• Receive, enter, and track inbound referrals from internal and external sources for all three outpatient clinics; route each referral to the appropriate service and work queue.
• Review referrals for administrative completeness, including patient identifiers, contact information, referring provider, referral order, requested service, insurance information, and supporting records. Obtain missing information from the referring office or clinical team.
• Coordinate clinical review of inbound referrals when required, including provider acceptance, appropriateness of the requested service, and scheduling priority.
• Process outbound referrals ordered by clinic providers to specialists, diagnostic services, treatment programs, and other care resources. Confirm the intended destination with the ordering team when clarification is needed.
• Work with registration to verify patient demographics, insurance coverage, network participation, and referral or authorization requirements. Obtain and track referral-related authorizations as assigned, using clinical documentation supplied by the provider or MA.
• Send referral orders and supporting records through approved communication channels; confirm receipt and follow up on incomplete, declined, or redirected referrals.
• Coordinate with providers and MAs to obtain documentation, clarify orders through the clinical team, and resolve referral barriers. Communicate referral status and outstanding actions to the appropriate staff.
• Coordinate with registration and scheduling staff to arrange appointments, communicate provider-approved scheduling priorities, and avoid duplicate scheduling or referrals.
• Contact patients regarding referral status, appointment arrangements, preparation instructions supplied by the receiving office, and outstanding administrative requirements. Document outreach attempts and patient responses.
• Identify barriers such as inability to contact the patient, insurance restrictions, transportation concerns, limited appointment availability, or patient refusal; coordinate available assistance and escalate unresolved issues.
• Maintain accurate referral records in the electronic health record or designated tracking system, including receipt and transmission dates, authorization status, appointment dates, outreach, barriers, and next follow-up actions.
• Monitor pending referrals and follow up until the referral is completed or another disposition is documented. Obtain consultation reports or other applicable completion documentation, route them to the ordering provider, and track any requested follow-up.
• Document cancellations, missed appointments, declined referrals, and unsuccessful outreach. Notify the ordering team and close referrals only in accordance with approved workflows.
• Promptly route urgent referrals, reported symptoms, and clinical concerns to the appropriate provider, nurse, or MA under established escalation procedures. Clinical triage and decisions about urgency remain with qualified clinical staff.
• Provide the Patient Access Supervisor with referral activity reports and information about aging referrals, processing delays, authorization barriers, completion rates, and recurring workflow issues.
• Participate in referral process improvement, staff training, and coordination meetings across CFHC, CBHW, and CSA.
• Protect patient confidentiality and follow organizational privacy, records-release, documentation, and secure communication procedures, including applicable restrictions on behavioral health information.
• Perform other duties related to patient access and referral coordination as assigned.