Referral Coordinator (CC26134 - NIC)

CommuniCare•San Antonio, TX

10d

About The Position

The Referral Coordinator answers telephone calls, schedules appointments, and provides customer service. The role processes referrals for Adult Medicine, Pediatric, Medical Specialty, and Behavioral Health providers. It verifies insurance coverage and benefits, obtains treatment authorizations as required by insurance plans and payer guidelines, and records referral, authorization, and communication details in the Electronic Health Record (EHR). The coordinator manages appointment scheduling and referral workflows, maintains accurate patient and insurance information, communicates with patients and healthcare providers, and follows privacy and customer-service procedures. Scheduled hours and/or work locations are subject to change.

Requirements

High school graduate or equivalent.
At least one year of customer service experience; healthcare setting preferred.
Excellent oral and written communication and interpersonal skills.
Proficient with personal computers, including Microsoft Word, Excel, and Outlook.
Ability to handle multiple tasks efficiently with minimal supervision.

Nice To Haves

Medical referral experience.
Experience with EMR/EHR systems and medical terminology.
Experience with insurance verification and healthcare billing.
Bilingual in English and Spanish.

Responsibilities

Schedule patient appointments using established provider templates; maintain accurate and up-to-date patient demographics and insurance information in the EHR.
Coordinate with providers and support staff to optimize appointment templates and make patient schedule changes as needed.
Document and relay information to external providers as appropriate to facilitate patient care.
Answer telephone calls using appropriate etiquette and provide prompt, courteous service.
Participate in new initiatives and processes, suggest improvements to call flow and communication, and contribute to continuous service improvement.
Follow patient privacy and protected health information policies; report potential privacy breaches, HIPAA violations, or suspicious activity to the appropriate supervisor or chain of command.
Process referrals according to order date and urgency, track referrals through completion, prevent backlogs, and maintain communication among staff, providers, and patients.
Coordinate appointment scheduling among patients, primary care providers, and specialty providers; report unusual delays, insurance issues, or other barriers to a supervisor or provider.
Inform patients when referral processing is incomplete, explain the reason, provide feedback through messaging or telephone, and give additional instructions as needed.
Provide customer service through telephone, messaging system, and fax to assist patients with healthcare needs.
Perform other related duties as assigned.