Referral Coordinator

AHS Vista•Waukegan, IL

1d•Onsite

About The Position

The Referral Coordinator / Insurance Verifier plays a vital role in ensuring patients receive timely, coordinated care while supporting accurate reimbursement. This position is responsible for managing provider referrals and verifying patient insurance coverage, benefits, and authorization requirements. Serving as a key liaison between patients, providers, and insurance carriers, this role requires strong attention to detail, a working knowledge of insurance processes, and excellent communication skills to support efficient patient flow and regulatory compliance.

Requirements

High school diploma or equivalent
Minimum of two (2) years' experience in a hospital or medical-related environment
Working knowledge of medical insurance and the insurance industry required
At least one (1) year of customer service experience
Proficiency with computers and standard office equipment
Strong organizational skills, attention to detail, and communication abilities

Responsibilities

Receive, review, and process incoming and outgoing referrals in compliance with payer and organizational requirements
Verify patient insurance eligibility, benefits, coverage limitations, and authorization requirements prior to services being rendered
Obtain prior authorizations and referrals from insurance carriers, primary care providers, and specialists as required
Accurately document insurance verification details, referral status, authorization numbers, and related communications in the EHR or practice management system
Communicate clearly with patients regarding insurance coverage, referral requirements, financial responsibility, and next steps in scheduling care
Coordinate with clinical staff, scheduling teams, and external provider offices to ensure referrals are complete and services are scheduled appropriately
Contact insurance companies to clarify benefits, resolve discrepancies, appeal authorization or referral denials, and confirm payer policies
Monitor referral and authorization turnaround times to minimize delays in patient care
Maintain compliance with HIPAA, payer contracts, and organizational policies when handling protected health information (PHI)
Identify and escalate insurance coverage issues, referral denials, or incomplete documentation to appropriate leadership or billing teams
Support billing and revenue cycle processes by ensuring all referrals and authorizations are complete and accurate prior to claim submission
Stay current on changes in insurance plans, referral guidelines, and authorization requirements for common payers