Referral Coordinator I

Primary Responsibilities 

• Initiates and processes routing clinical referrals and authorization requests following established procedures.   

• Serves as a liaison between hospital, health plans, physicians, patients, vendors and other referral sources to support referral coordination.  

• Reviews referrals for completeness and accuracy and follows up for additional information if necessary.  

• Verifies insurance coverage and initiates pre-authorization requests in accordance with payer requirements and established workflows.  

• Responds to inbound requests related to referral processing while meeting productivity and quality standards. 

• Contacts physician offices as needed to obtain demographic information or related data.  

• Enters referrals, documents communications, actions and related information in system.  

• Escalates complex referral issues or authorization concerns to senior referral coordinators or leadership as appropriate.  

Minimum Qualifications 

• High school diploma or GED and minimum of 1 year of customer service or healthcare administrative experience required; or any combination of education and experience which would provide an equivalent background. 

• Medical Assistant certificate / certification from an accredited training program required. 

• Knowledge of medical terminology, plan specific guidelines; ICD-9 and CPT coding preferred.