Referral Coordinator

COQUILLE INDIAN TRIBE•Eugene, OR

2d•$22 - $28

About The Position

The Coquille Indian Tribe operates the Ko-Kwel Wellness Center (KWC) with clinics located in Coos Bay and Eugene, Oregon. The KWC offers primary care, dental, pharmacy, nutrition, physical and massage therapy, behavioral health, and substance use disorder services. The Referral and Prior Authorization Coordinator supports KWC providers and care teams by managing the referral process for patients requiring specialty care, diagnostic testing, or other services. Referrals may be internal between KWC providers or external between KWC and outside providers. The position ensures timely processing of referrals, obtains insurance prior authorizations when required, and coordinates communication between patients, providers (referring and referred), and insurers to support continuity of care.

Requirements

Excellent oral and written communication skills with strengths in collaboration, team building, and problem solving 3 04/26
Ability to convey a calm, respectful, and supportive demeanor in stressful or emotionally charged situations
Ability to foster an inclusive environment where diversity and individual differences are valued
Ability to make independent decisions in accordance with established regulations, policies and procedures
Strong organizational skills and ability to set priorities and exercise sound judgment
Ability to work cooperatively across departments and build effective working relationships
Ability to work within an electronic health records system and/or electronic patient management system.
Working knowledge of medical terminology
High School diploma or equivalent required
Three (3) years of experience in a medical office or healthcare administrative role required
First Aid, CPR, and QPR certification required or ability to obtain within ninety days
Current and valid driver’s license in good standing with no insurability restrictions

Nice To Haves

Experience with insurance referrals, prior authorizations, and care coordination processes preferred
Experience with the Ochin/Epic electronic health record (EHR) system and understanding of referral work queues preferred
Ability to collaborate professionally and effectively with internal and external partners
Experience working for a tribe or tribal organization preferred

Responsibilities

Receive and process internal and external referral orders from providers
Coordinate scheduling internally within the KWC and externally with specialty clinics and providers
Track referrals from initiation through completion to ensure patients receive recommended care
Work with providers to renew referrals as necessary
Maintain accurate documentation in the electronic health record (EHR) 2 04/26 Prior Authorizations and Insurance
Verify insurance eligibility and referral requirements
Obtain prior authorizations when required by payer guidelines and create prior authorizations through insurance portals (e.g., Evicore, OneHealth Port, Availity, OneHealth Care) as required
Submit necessary clinical documentation to specialty clinics or insurance carriers
Follow up on pending authorizations and resolve denials when appropriate Patient and Client Coordination
Contact patients and clients to explain referral instructions and scheduling details
Assist patients and clients in navigating specialty care appointments
Provide preparation instructions for diagnostic tests or specialty visits
Address patient and client questions related to referrals and next steps in care Provider and Care Team Support
Communicate referral status updates with providers, medical assistants, and care teams
Coordinate with referred providers and clinics to ensure timely access for patients and clients
Assist providers with referral diagnosis codes and documentation requirements Documentation and Compliance
Maintain referral tracking logs and EHR documentation
Ensure compliance with HIPAA and KWC policies
Assist with quality improvement initiatives related to referral completion rates and care coordination metrics