Coordinator, Referrals

Cano Health•Sun City, FL

About The Position

The Referral Coordinator supports patient care coordination by managing insurance pre-verifications, referral processing, appointment scheduling, and communication among patients, providers, specialists, and health plans. The role ensures timely and accurate handling of internal and external referrals, authorizations, and follow-up activities while providing patient-centered service. The coordinator processes and tracks referrals, obtains required authorizations, schedules specialist appointments, follows up on incomplete referrals, and ensures consultation reports reach the appropriate provider. The role also educates patients about referral and insurance requirements and helps address logistical or administrative barriers. The position supports value-based care and quality initiatives by scheduling referrals associated with HEDIS, STAR, and QI measures; documenting information for risk adjustment and quality reporting; and helping direct patients to in-network or preferred providers. It collaborates with clinical and administrative teams, maintains accurate EHR documentation, protects patient privacy, and assists with clinic operations and patient flow. The role works under usual office conditions, uses a computer and phone for extended periods, and requires travel to assigned clinics or territories as needed. Extended and flexible hours and weekends may be required.

Requirements

High school diploma or GED.
At least 1–2 years of experience in a medical office, hospital, or clinical setting handling referrals.
Working knowledge of medical terminology and insurance processes.
Experience with scheduling systems, EHRs such as eClinicalWorks, and insurance authorization procedures.
BLS certification and ability to respond appropriately in emergencies.
Proficiency in Microsoft Office Suite, including Excel, Word, Teams, and PowerPoint.
Familiarity with insurance portals, including Medicaid, Medicare, and commercial payers.
Strong customer service, organizational, and time-management skills.
Ability to navigate multiple systems, including eClinicalWorks, Availity, Cano.Net, Workday, Oracle, and health plan and diagnostic center portals.
Ability to work at a personal computer and be on the phone for extended periods.
Ability to stand, sit, walk, and occasionally climb; ability to lift up to 50 pounds.
Ability to work extended and flexible hours and weekends as needed.
Ability to travel to clinical sites as needed; expected travel is 0–25%.

Nice To Haves

Bilingual ability in English and Spanish.

Responsibilities

Process outgoing referrals based on provider orders, review and document referral orders, and enter referrals and authorizations into appropriate systems.
Schedule appointments with specialists or service providers, prioritizing high-quality, in-network, and cost-effective options.
Track referral status, follow up on incomplete referrals, obtain consultation reports, and route documentation to the appropriate provider.
Educate patients about referral processes, insurance requirements, and expectations; communicate appointment details and authorization status.
Help patients address transportation, language, scheduling, and other administrative or logistical barriers.
Verify insurance eligibility and referral requirements; obtain prior authorizations and approvals from health plans.
Collaborate with payers and specialists to expedite authorizations and respond to denials or appeals.
Schedule referrals related to HEDIS, STAR, and Quality Improvement measures and support documentation for risk adjustment and quality reporting.
Track referral patterns and guide patients toward in-network or preferred providers aligned with ACOs and narrow-network strategies.
Identify and escalate referral delays or barriers that could affect clinical outcomes or contractual performance metrics.
Maintain accurate and timely referral documentation in the EHR and log referral status, actions, and communications.
Generate and distribute referral forms, notifications, and supporting documents.
Coordinate care with physicians, nurses, medical assistants, and care managers; participate in daily huddles and share referral updates.
Follow HIPAA guidelines and clinic protocols, and securely communicate patient records to external entities.
Provide clerical support, help manage lobby areas and PPE protocols, and coordinate with front desk and clinic staff to support scheduling and patient flow.
Provide compassionate, professional patient support in person and over the phone, serving as a patient advocate and fostering a positive, organized environment.
Travel to assigned clinical sites as needed.