Referral Coordinator
Community Alliance Medical Group, Redlands, CA, United States
We are seeking a proactive and detail-oriented Referral coordinator to join our dynamic healthcare team. In this vital role, you will serve as a key connector between patients, healthcare providers and insurance companies, ensuring seamless coordination of referrals and authorizations. Your expertise will help facilitate efficient patient care pathways, manage medical records, and verify insurance coverage, all while maintaining compliance with HIPAA regulations. If you thrive in a fast‑paced environment and are passionate about improving patient experiences through effective communication and organization, this is the perfect opportunity for you to make a meaningful impact.
Responsibilities
Coordinate and process patient referrals across various medical specialties, ensuring timely follow‑up and documentation.
Verify insurance coverage and benefits through insurance verification processes to confirm patient eligibility.
Maintain accurate medical records, including documentation of referrals, authorizations, and related correspondence in compliance with HIPAA standards.
Utilize medical terminology, CPT (Current Procedural Terminology) coding, ICD (International Classification of Diseases) coding (ICD-9, ICD-10), and medical coding practices to ensure proper documentation.
Collaborate with healthcare providers and insurance companies to obtain prior authorizations for procedures or treatments as required.
Manage office workflows related to referral processing, including data entry, appointment scheduling, and follow‑up communications.
Stay informed about managed care policies and updates to ensure adherence to industry standards and regulations.
Qualifications
Prior experience working in a medical office setting is highly preferred.
Strong knowledge of managed care processes, insurance verification procedures, and medical billing/coding practices.
Familiarity with HIPAA regulations to ensure patient confidentiality and data security.
Proficiency in medical terminology along with CPT coding, ICD-9/ICD-10 coding systems, and medical records management.
Excellent organizational skills with the ability to handle multiple tasks efficiently in a busy environment.
Office experience demonstrating strong communication skills and attention to detail.
Knowledge of medical records management systems or electronic health records (EHR) is advantageous.
Education and Experience Requirements
High school diploma, GED, or equivalent
Knowledge of medical terminology
Experience in insurance authorization (strongly preferred)
Knowledge of telephone systems and computer systems
Ability to work with a team
Ability to work under pressure
Physical Requirements and Work Environment
*The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Ability to operate office equipment, including computer and copier equipment. Must be able to sit or stand for long periods of time, with occasional walking. Ability to bend and lift 30 or more pounds. Hearing and vision required.
Policies and Procedures
Protects patients’ rights by maintaining confidentiality of personal and financial information. Maintains operations by following policies and procedures; reporting needed changes. Protects patient confidentiality by making sure protected health information (PHI) is secured by not leaving PHI in plain sight and logging of the computer before leaving it unattended. Other duties as assigned.
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Responsibilities
Coordinate and process patient referrals across various medical specialties, ensuring timely follow‑up and documentation.
Verify insurance coverage and benefits through insurance verification processes to confirm patient eligibility.
Maintain accurate medical records, including documentation of referrals, authorizations, and related correspondence in compliance with HIPAA standards.
Utilize medical terminology, CPT (Current Procedural Terminology) coding, ICD (International Classification of Diseases) coding (ICD-9, ICD-10), and medical coding practices to ensure proper documentation.
Collaborate with healthcare providers and insurance companies to obtain prior authorizations for procedures or treatments as required.
Manage office workflows related to referral processing, including data entry, appointment scheduling, and follow‑up communications.
Stay informed about managed care policies and updates to ensure adherence to industry standards and regulations.
Qualifications
Prior experience working in a medical office setting is highly preferred.
Strong knowledge of managed care processes, insurance verification procedures, and medical billing/coding practices.
Familiarity with HIPAA regulations to ensure patient confidentiality and data security.
Proficiency in medical terminology along with CPT coding, ICD-9/ICD-10 coding systems, and medical records management.
Excellent organizational skills with the ability to handle multiple tasks efficiently in a busy environment.
Office experience demonstrating strong communication skills and attention to detail.
Knowledge of medical records management systems or electronic health records (EHR) is advantageous.
Education and Experience Requirements
High school diploma, GED, or equivalent
Knowledge of medical terminology
Experience in insurance authorization (strongly preferred)
Knowledge of telephone systems and computer systems
Ability to work with a team
Ability to work under pressure
Physical Requirements and Work Environment
*The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Ability to operate office equipment, including computer and copier equipment. Must be able to sit or stand for long periods of time, with occasional walking. Ability to bend and lift 30 or more pounds. Hearing and vision required.
Policies and Procedures
Protects patients’ rights by maintaining confidentiality of personal and financial information. Maintains operations by following policies and procedures; reporting needed changes. Protects patient confidentiality by making sure protected health information (PHI) is secured by not leaving PHI in plain sight and logging of the computer before leaving it unattended. Other duties as assigned.
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