Referrals Coordinator

Aviva Health•Roseburg, OR

1d•$19 - $24•Onsite

About The Position

The Referrals Coordinator works under the supervision of the Referrals and Medical Records Supervisor to facilitate accurate, timely, and efficient processing of internal and external patient referrals, insurance authorizations, advanced imaging orders, and medication prior authorizations. The role collaborates with providers, patients, insurance carriers, pharmacies, specialty offices, and other healthcare professionals to support continuity of care and access to services. The coordinator manages multiple requests, prioritizes work based on urgency, resolves barriers, and maintains accurate documentation throughout the referral and authorization process. The role requires strong organizational skills, attention to detail, sound judgment, and compassionate, professional communication to support patient experience and clinical operations. This is an in-person position during normal business hours in an indoor, heat-controlled office environment. The normal work routine involves no exposure to blood, body fluids, or tissues. Employees must be able to perform the position’s essential functions, with reasonable accommodation where applicable.

Requirements

High school diploma or equivalent.
Ability to accurately interpret referral orders, clinical documentation, insurance requirements, and authorization information.
Proficiency in computer applications, data entry, and standard office equipment, with the ability to learn new systems and technology.
Strong organizational and time-management skills, including the ability to manage multiple responsibilities independently, prioritize competing deadlines, and maintain accuracy.
Effective verbal and written communication skills for communicating with patients, healthcare professionals, insurance representatives, and external organizations.
Ability to identify discrepancies, investigate issues, exercise sound judgment, and resolve problems within established guidelines.
Ability to maintain confidentiality and handle sensitive patient information in accordance with HIPAA and organizational policies.
Ability to work independently and collaboratively in a fast-paced healthcare environment.
Ability to remain stationary frequently, move or traverse occasionally around the office, and operate a computer and other standard office equipment frequently.
Ability to communicate information and ideas clearly and accurately and interact clearly with patients and staff.
Ability to move or transport up to 5 pounds, such as a laptop or office supplies.
Previous experience in a healthcare setting, medical office, referral coordination, insurance authorization, or a related administrative position is preferred, not required.
Experience using electronic medical records and healthcare computer applications is preferred, not required.
Knowledge of medical terminology, healthcare documentation, referral procedures, insurance verification, and prior authorization processes is preferred, not required.
Familiarity with insurance payer requirements, specialty referral processes, and applicable healthcare regulations is preferred, not required.
Must pass a drug screening and criminal background check as a condition of employment; compliance with the drug-free workplace policy is required throughout employment.

Nice To Haves

Previous experience in a healthcare setting, medical office, referral coordination, insurance authorization, or a related administrative position.
Experience using electronic medical records and healthcare computer applications.
Knowledge of medical terminology, healthcare documentation, referral procedures, insurance verification, and prior authorization processes.
Familiarity with insurance payer requirements, specialty referral processes, and applicable healthcare regulations.

Responsibilities

Review and process referral orders through the electronic medical record (EMR), verifying completeness, medical necessity, and insurance requirements; identify appropriate specialists or facilities when not specified by the provider.
Process internal and external referrals, ensuring required clinical documentation and insurance authorizations are obtained and submitted to specialty offices or facilities.
Monitor outstanding referrals and incomplete clinical documentation, following up with providers when chart notes remain incomplete after 72 hours.
Obtain and process insurance prior authorizations for specialty referrals, diagnostic imaging, procedures, and other services; verify coverage requirements and document authorization details in the EMR.
Review and process medication prior authorization requests daily, coordinating with providers, pharmacies, and insurance carriers.
Investigate denied or delayed referrals and authorizations, coordinating to obtain additional documentation, pursue reconsideration, or identify alternatives.
Coordinate Veterans Community Care referrals and authorizations in accordance with program requirements.
Maintain complete and timely EMR documentation of referral activities, authorization statuses, communications, and follow-up actions.
Monitor referral work queues, pending authorizations, and outstanding requests; prioritize urgent patient needs and meet deadlines.
Communicate with patients about referral statuses, authorization requirements, scheduling instructions, and potential delays, providing clear information and assistance.
Collaborate with providers, clinical staff, specialty offices, pharmacies, and insurance representatives to clarify orders, resolve discrepancies, and coordinate care.
Track referral outcomes, including completed appointments, declined services, unsuccessful contact attempts, and other relevant statuses; ensure appropriate follow-up and documentation.
Follow organizational policies, payer requirements, Patient-Centered Primary Care Home (PCPCH) standards, HIPAA regulations, and confidentiality requirements.
Use electronic medical records, referral management systems, and standard computer applications to process requests and support department operations.
Identify workflow barriers, adapt to changing priorities, contribute to process improvements, and assist with additional department responsibilities as assigned.
Take ownership of responsibilities, follow through on commitments, and meet expectations and deadlines.
Maintain accuracy and thoroughness when reviewing information, completing tasks, and keeping records.
Communicate clearly, respectfully, and professionally; listen actively and share information appropriately.
Support patients with compassion, patience, and cultural sensitivity.
Build positive working relationships and contribute to a respectful, cooperative, and productive work environment.
Anticipate challenges, identify improvement opportunities, and take appropriate action to resolve concerns within the position’s scope.
Respond constructively to changing priorities, procedures, and operational needs.
Exercise ethical judgment, discretion, reliability, and respect while upholding organizational values and confidentiality standards.