Job Description
Job Description
The Referral Coordinator is responsible for managing and processing patient referrals to specialists, diagnostic services, and ancillary providers. This role ensures referrals are completed accurately, authorized by insurance when required, and communicated effectively to patients and outside providers. The Referral Coordinator plays a critical role in maintaining continuity of care, compliance, and patient satisfaction.
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Receive, review, and process incoming and outgoing patient referrals from providers.
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Verify referral completeness, including diagnosis codes (ICD-10), procedure codes (CPT), clinical notes, and provider signatures.
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Submit referrals to insurance companies and track authorization status.
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Follow up on pending referrals and authorizations to ensure timely scheduling.
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Verify patient insurance eligibility and referral requirements.
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Obtain prior authorizations for specialty visits, procedures, imaging, and therapies.
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Communicate authorization approvals, denials, and required documentation to providers and patients.
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Maintain accurate records of authorization numbers and expiration dates.
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Educate patients on referral processes, timelines, and insurance requirements.
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Notify patients of referral status, appointment details, and next steps.
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Address patient questions and concerns related to referrals and authorizations in a professional and empathetic manner.
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Communicate with referring providers, specialists, hospitals, and diagnostic facilities.
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Coordinate appointments and ensure transfer of medical records and referral documentation.
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Ensure referrals comply with payer, provider, and regulatory requirements.
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Document all referral activities in the electronic health record (EHR) accurately and timely.
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Maintain confidentiality and comply with HIPAA regulations at all times.
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Audit referral records for accuracy and completeness.
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Assist with referral-related reporting and quality improvement initiatives.
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Maintain referral logs, spreadsheets, or tracking systems.
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Assist front office or clinical staff as needed.
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Stay current on insurance policies, referral guidelines, and office procedures.
Company DescriptionMedical Experience require for 2 more years.
Company Description
Medical Experience require for 2 more years.