Coordinator, Referrals

Cano Health • Kendall, FL

86d

About The Position

The Referral Coordinator plays a vital role in supporting patient care coordination by managing insurance pre-verifications, referral processing, appointment scheduling, and communication between patients, providers, and health plans. This individual ensures timely and accurate handling of all internal and external referrals, authorizations, and follow-up activities. The Referral Coordinator serves as a key liaison among clinics, specialists, and insurance carriers, while upholding a patient-centered and service-oriented approach.

Requirements

• High school diploma or GED required.
• Minimum of 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 (e.g., eClinicalWorks), and insurance authorization procedures.
• BLS certification required; must be able to respond appropriately in emergencies.

Nice To Haves

• Proficient in Microsoft Office Suite (Excel, Word, Teams, PowerPoint).
• Familiarity with insurance portals, including Medicaid, Medicare, and commercial payers.
• Bilingual in English and Spanish preferred.
• Strong customer service, organizational, and time management skills.
• Ability to navigate multiple systems including eClinicalWorks (eCW), Availity, Cano.Net (ticketing system), Workday (timekeeping/HR platform), Oracle (expense reporting), and health plan and diagnostic center portals.

Responsibilities

• Process outgoing referrals promptly based on provider orders (e.g., specialty care, diagnostics, therapy).
• Review, validate, and document referral orders, input referrals and authorizations into the appropriate data 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, and ensure timely receipt of consultation reports.
• Close the referral loop by ensuring reports and documentation are routed to the appropriate provider.
• Educate patients on the referral process, insurance requirements, and expectations.
• Assist patients in overcoming logistical or administrative barriers (e.g., transportation, language, scheduling).
• Notify patients of appointment details and authorization status.
• Provide compassionate, professional support in person and over the phone, reinforcing a positive patient experience.
• Verify insurance eligibility and determine referral and authorization requirements.
• Obtain prior authorizations and approvals from health plans as needed.
• Collaborate with payers and specialists to expedite authorizations and respond to denials or appeals.
• Proactive schedule referrals related to key quality metrics, including HEDIS, STAR, and Quality Improvement (QI) measures (e.g., mammograms, colonoscopies, diabetic eye exams).
• Support accurate and timely documentation to meet risk adjustment and quality reporting requirements.
• Track referral patterns and help guide patients to in-network or preferred providers aligned with Accountable Care Organizations (ACOs) and narrow network strategies.
• Identify, address, and escalate referral delays or barriers that may impact clinical outcomes or contractual performance metrics.
• Maintain accurate documentation of all referral activities in the Electronic Health Record (EHR) system.
• Log referral status, actions taken, and communications in a timely manner.
• Generate and distribute referral forms, notifications, and supporting documents.
• Work closely with physicians, nurses, medical assistants, and care managers to coordinate care.
• Participate in daily huddles to proactively address upcoming referral needs.
• Share referral status updates with clinical team members in real-time.
• Uphold HIPAA guidelines and clinic protocols related to data handling and patient confidentiality.
• Ensure secure communication of patient records to external entities.
• Provide clerical support to the clinical team, including managing lobby areas and assisting with PPE protocols.
• Collaborate with front desk and clinic staff to monitor scheduling and patient flow.
• Maintain a welcoming and organized patient experience environment.

What This Job Offers

• Industry: Ambulatory Health Care Services
• Education Level: High school or GED
• Number of Employees: 1,001-5,000 employees