Referral Coordinator

Encompass Medical Group•Lenexa, KS

About The Position

The Referral Coordinator is responsible for pre-certification, pre-authorization, and other specialty referrals, and for organizing and prioritizing daily workflow to maintain efficient patient flow. The role involves professional interactions with physicians, receptionists, ancillary services, patients, insurers, and outside providers. The coordinator assembles clinical and referral information, supports patients in navigating healthcare and related barriers, advocates for timely approval of necessary services, and coordinates care and communications with consultants and community resources. The position also supports registration and insurance verification, referral and order tracking, appointment reminders and scheduling, care-gap outreach, chart updates, and patient confidentiality. If credentialed, the coordinator performs transition-of-care communications. Other duties may be assigned by the Clinical Coordinator and/or Medical Office Manager. Travel may be required to provide coverage at other clinics.

Requirements

High school graduate or equivalent.
Medical terminology.
Previous receptionist or customer service skills.
Previous work experience in a medical setting.
Good phone and voicemail etiquette.
Strong computer skills.
Excellent typing, writing, and spelling skills.
Ability to communicate effectively with office personnel and the public.
Ability to work with minimal supervision.
Any equivalent combination of experience and training that provides the required knowledge, skills, and abilities.

Nice To Haves

Basic Cardiac Life Support Certification; obtaining and maintaining certification is preferred but not required.
Previous referral coordination experience.
Knowledge of medical field terminology.
Prior office or clerical experience.

Responsibilities

Follow up with specialty providers who have not sent summaries or reports within the identified standard.
Ensure complete and accurate patient registration, including demographics and current insurance information.
Assemble information concerning patients’ clinical backgrounds and referral needs.
Contact insurance companies and organizations to ensure prior-approval requirements are met.
Present necessary medical history, diagnosis, and prognosis information.
Provide specific medical information to financial services to maximize reimbursement to companies, organizations, and physicians.
Review referral details and expectations with patients.
Help patients address potential healthcare-system, financial, or social barriers, including requesting interpreters or transportation services as appropriate.
Serve as a point of contact for patients’ questions and concerns.
Advocate with carriers to ensure timely approval of necessary supplies and services.
Identify and use cultural and community resources.
Establish and maintain relationships with service providers.
Ensure referrals are addressed promptly in accordance with organizational processes.
Remind patients of scheduled appointments by phone, voicemail, or mail.
Update the patient’s primary care chart with information about consults, hospitalizations, ER visits, and community organizations related to their healthcare.
Coordinate care with outside consultants for additional patient care.
Provide assistance in other areas as assigned by the Clinical Coordinator and/or Medical Office Manager, and perform other duties as assigned.
Work with physicians to ensure documentation is in order for patient specialty and hospital referrals.
Verify patient insurance information to determine patient responsibility.
Assist patients with social determinant needs as needed.
Perform transition-of-care communications with patients if credentialed.
Carry out care-management activities, including pre-visit planning and order creation based on care gaps.
Conduct patient outreach based on care gaps.
Assist with general incoming phone calls and scheduling.
Monitor uncompleted orders and referrals to support patient compliance.
Maintain patient confidentiality.