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The Patient Referral Coordinator manages the complete referral cycle for FQHC patients, including specialist referrals, diagnostic services, insurance authorization, appointment coordination, follow-up, and documentation. This position ensures patients receive timely access to medically necessary care while complying with payer requirements, referral protocols, HIPAA, and health-center policies.
Essential Duties and Responsibilities
Receive referral orders from providers and verify required clinical information.
Review referrals for completeness, accuracy, urgency, diagnosis, and supporting records.
Enter and update referrals in the EHR and referral-management system.
Send referral packets, medical records, authorization requests, and other required documents to specialists or facilities.
Confirm that the receiving specialist or facility accepts the referral and has all necessary information.
Verify insurance eligibility, benefits, network status, and referral or authorization requirements.
Submit prior-authorization requests to insurance plans and track approvals, denials, pending requests, and expiration dates.
Obtain referrals, authorizations, or approval extensions from insurance companies when required.
Communicate with specialists, hospitals, testing facilities, managed-care plans, providers, and patients to resolve delays or missing information.
Schedule appointments when permitted and communicate appointment details to patients.
Follow up with patients who have not scheduled or completed referred services.
Track urgent referrals through completion and escalate overdue or high-risk cases.
Document every contact, submission, approval, denial, scheduling effort, and patient notification in the EHR.
Close the referral loop by obtaining specialist reports and forwarding results to the referring provider.
Assist uninsured and underinsured patients with financial-assistance options, sliding-fee programs, transportation, interpretation, and other access barriers.
Maintain confidentiality of protected health information and release records only according to authorization and policy.
Prepare referral-status reports and participate in quality-improvement activities.
Minimum Qualifications
High school diploma or equivalent.
One or more years of experience in medical referrals, authorization, insurance verification, scheduling, care coordination, or a comparable healthcare-access role.
Knowledge of medical terminology and basic insurance concepts.
Experience using an EHR system and Microsoft Office.
Strong organizational skills and attention to detail.
Professional phone, written, and interpersonal communication skills.
Ability to manage competing priorities and meet referral turnaround requirements.
Commitment to culturally responsive, patient-centered service.
Preferred Qualifications
Associate degree or certificate in health information, medical assisting, healthcare administration, or a related field.
Experience in an FQHC, community health center, primary-care clinic, or managed-care environment.
Experience with Medicaid, Medicare, commercial insurance, and managed-care referrals.
Bilingual capability, particularly English and Spanish.
Familiarity with referral-management systems and prior-authorization portals.
Additional Requirements
Maintain HIPAA and patient-confidentiality standards.
Complete required FQHC compliance, safety, and cultural-competency training.
Work effectively with patients experiencing language, financial, transportation, or healthcare-navigation barriers.
Perform duties in a manner consistent with the health center’s mission and nondiscrimination policies.
