Referral Coordinator

CIBOLA GENERAL HOSPITAL CORPORATION•Grants, NM

About The Position

The Referral Coordinator manages inbound and outbound referrals across CFHC, CBHW, and CSA to support timely access to care and continuity between referring and receiving providers. This position works closely with providers, registration staff, medical assistants (MAs), patients, and external offices to obtain complete referral information, coordinate referral-related insurance requirements and scheduling, monitor progress, and ensure consultation reports are received and routed to the appropriate provider. The Referral Coordinator reports to the Patient Access Supervisor and escalates clinical questions and urgency concerns to the appropriate clinical team.

Requirements

Manage inbound and outbound referrals
Support timely access to care and continuity between providers
Work with providers, registration staff, MAs, patients, and external offices
Obtain complete referral information
Coordinate referral-related insurance requirements and scheduling
Monitor referral progress
Ensure consultation reports are received and routed
Escalate clinical questions and urgency concerns
Receive, enter, and track inbound referrals
Route referrals to appropriate service and work queue
Review referrals for administrative completeness
Obtain missing information
Coordinate clinical review of inbound referrals
Process outbound referrals
Confirm intended destination of outbound referrals
Verify patient demographics, insurance coverage, network participation, and referral/authorization requirements
Obtain and track referral-related authorizations
Send referral orders and supporting records
Confirm receipt and follow up on incomplete, declined, or redirected referrals
Coordinate with providers and MAs to obtain documentation
Clarify orders through the clinical team
Resolve referral barriers
Communicate referral status and outstanding actions
Coordinate with registration and scheduling staff to arrange appointments
Communicate provider-approved scheduling priorities
Avoid duplicate scheduling or referrals
Contact patients regarding referral status, appointment arrangements, preparation instructions, and outstanding administrative requirements
Document outreach attempts and patient responses
Identify barriers (e.g., inability to contact patient, insurance restrictions, transportation concerns, limited appointment availability, patient refusal)
Coordinate available assistance
Escalate unresolved issues
Maintain accurate referral records in EHR or designated tracking system
Monitor pending referrals and follow up until completion or disposition
Obtain consultation reports or other applicable completion documentation
Route completion documentation to ordering provider
Track requested follow-up
Document cancellations, missed appointments, declined referrals, and unsuccessful outreach
Notify ordering team and close referrals according to approved workflows
Promptly route urgent referrals, reported symptoms, and clinical concerns
Provide referral activity reports to Patient Access Supervisor
Report on aging referrals, processing delays, authorization barriers, completion rates, and recurring workflow issues
Participate in referral process improvement, staff training, and coordination meetings
Protect patient confidentiality
Follow organizational privacy, records-release, documentation, and secure communication procedures
Adhere to applicable restrictions on behavioral health information
Perform other duties related to patient access and referral coordination

Responsibilities

Receive, enter, and track inbound referrals from internal and external sources for all three outpatient clinics; route each referral to the appropriate service and work queue.
Review referrals for administrative completeness, including patient identifiers, contact information, referring provider, referral order, requested service, insurance information, and supporting records. Obtain missing information from the referring office or clinical team.
Coordinate clinical review of inbound referrals when required, including provider acceptance, appropriateness of the requested service, and scheduling priority.
Process outbound referrals ordered by clinic providers to specialists, diagnostic services, treatment programs, and other care resources. Confirm the intended destination with the ordering team when clarification is needed.
Work with registration to verify patient demographics, insurance coverage, network participation, and referral or authorization requirements. Obtain and track referral-related authorizations as assigned, using clinical documentation supplied by the provider or MA.
Send referral orders and supporting records through approved communication channels; confirm receipt and follow up on incomplete, declined, or redirected referrals.
Coordinate with providers and MAs to obtain documentation, clarify orders through the clinical team, and resolve referral barriers. Communicate referral status and outstanding actions to the appropriate staff.
Coordinate with registration and scheduling staff to arrange appointments, communicate provider-approved scheduling priorities, and avoid duplicate scheduling or referrals.
Contact patients regarding referral status, appointment arrangements, preparation instructions supplied by the receiving office, and outstanding administrative requirements. Document outreach attempts and patient responses.
Identify barriers such as inability to contact the patient, insurance restrictions, transportation concerns, limited appointment availability, or patient refusal; coordinate available assistance and escalate unresolved issues.
Maintain accurate referral records in the electronic health record or designated tracking system, including receipt and transmission dates, authorization status, appointment dates, outreach, barriers, and next follow-up actions.
Monitor pending referrals and follow up until the referral is completed or another disposition is documented. Obtain consultation reports or other applicable completion documentation, route them to the ordering provider, and track any requested follow-up.
Document cancellations, missed appointments, declined referrals, and unsuccessful outreach. Notify the ordering team and close referrals only in accordance with approved workflows.
Promptly route urgent referrals, reported symptoms, and clinical concerns to the appropriate provider, nurse, or MA under established escalation procedures. Clinical triage and decisions about urgency remain with qualified clinical staff.
Provide the Patient Access Supervisor with referral activity reports and information about aging referrals, processing delays, authorization barriers, completion rates, and recurring workflow issues.
Participate in referral process improvement, staff training, and coordination meetings across CFHC, CBHW, and CSA.
Protect patient confidentiality and follow organizational privacy, records-release, documentation, and secure communication procedures, including applicable restrictions on behavioral health information.
Perform other duties related to patient access and referral coordination as assigned.