Medical Referral Coordinator

A Hospital in Los Angeles is in the need of a Medical Referral Coordinator. The Medical Referral Coordinator is responsible for managing all patient referrals to specialists, diagnostic testing, and outside healthcare providers. This role ensures timely and accurate coordination of referrals, prior authorizations, and follow-up, while maintaining excellent communication with patients, providers, and insurance companies. The Medical Referral Coordinator plays a key role in supporting continuity of care and enhancing the patient experience.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

•Receive, review, and process all provider referral requests.

•Verify patient insurance eligibility and benefits related to referrals and authorizations.

•Obtain prior authorizations from insurance companies as required.

•May schedule referral appointments directly on behalf of patient, as needed.

•Track and follow up on referrals to confirm appointment completion and ensure receipt of consult/specialty notes in a timely manner.

•Ensure referrals are addressed and closed in a timely manner, as determined in relevant policies and procedures.

•Ensure that patient's primary care chart is up to date with information on specialist consults, hospitalizations, ER visits and community organization related to their health.

•Coordinates with clinical team on patient inquiries regarding referral.

•Maintain accurate and up-to-date referral logs and documentation in the electronic health record (EHR).

•Responsible to audit information entered in EHR to ensure compliance with capturing necessary data as required by reporting agencies (i.e. Meaningful Use, etc.).

•Communicate with providers regarding referral status, barriers, or delays.

•Communicate with Supervisor when unable to process all referrals or follow-ups to avoid delays.

•Serve as a patient advocate by providing education and guidance regarding referral processes and answer patient questions and address concerns.

•Ensure compliance with requirements of HIPAA, OSHA, other application regulations and all agency/clinic policies and protocols.

•Complete and comply with all mandatory trainings

•Participate in staff meetings, agency meetings, planning meetings, and other meetings as needed.

•Prepare and submit monthly reports of activities as requested.

•Identify and utilize cultural and community resources. Establish and maintain relationships with identified service providers.

•Participate in quality improvement initiatives related to referral management, providing feedback and suggestions to streamline processes and enhance patient care.

• High school diploma or equivalent.

• At least 3 year of experience in a healthcare or clinical environment, ideally in insurance referrals, scheduling, medical office support, or related administrative work.

• Working knowledge of insurance verification, authorization procedures, and healthcare documentation practices.

• Experience using electronic records platforms, medical billing systems, and computerized administrative tools.

• Familiarity with medical insurance functions, medical billing collections, insurance statements, and general revenue support tasks.

• Strong communication and patient service skills with the ability to interact effectively with patients, providers, and insurance contacts.

• Excellent attention to detail, organization, and follow-through when managing multiple cases and deadlines simultaneously.