Referral Coordinator
Boston, MA
Job Description

Under the supervision of the Directors of Patient Services and the Referral Supervisor, the Referral Coordinator is responsible for the processing of insurance referrals, professional communication with both internal and external clients, the registration and documentation of patients at check in as needed, and the provision of excellent customer service.

Representative Duties:

  • Accurately set up referrals for all patients and send to specialists in a timely manner
  • Respond to requests regarding authorization for services
  • Consult with PCPs to make decisions when specialists are unavailable
  • Prepare authorizations using insurance company websites or calls to managed care companies
  • Obtain, distribute and document referral authorization numbers
  • Input referral numbers into CPS and monitor cancellations, expirations and changes to referrals
  • Track services provided to managed care patients off-hours and in emergency
  • Schedule radiology and specialist appointments when instructed by a PCP
  • Educate patients, providers and staff to the various managed care programs
  • Educate patients toward proactive use of managed care companies and referral authorization process
  • Inform providers and /or patients of plan changes
  • Monitor and update managed care member listings and verify membership eligibility
  • Communicate plan updates to coworkers and replace obsolete information
  • Update specialty provider offices regarding changing insurance company requirements
  • Meet with insurance company representatives to learn updates or pertinent referral information
  • Research problems related to billing services for primary care
  • Proactively process referrals for specialists working at FH sites
  • Assist patients and patient services staff in calling insurance companies to change PCPs to FH or obtain referrals from outside providers to FH PCPs Inform patients that they will face a financial obligation if they fail to change their PCP with their insurance company to a FH provider, or obtain a referral to FH
  • Referral tracking
  • Assign referral a tracking modifier
  • Request clinical notes from specialist office after patient?s visit
  • Obtain clinical notes via fax and Careweb
  • Interoffice clinical notes to Fenway provider
  • Locate the tracking referral and complete the referral process
  • Accurately performs registration process for new and existing patients
  • Accurately register new patient demographic data in CPS
  • Obtain patient insurance data, completed and signed documentation (IIF) and copy of insurance card entering information into CPS accurately
  • Ask each patient at check in to verify existing demographic information and insurance information
  • Accurately record and enter any changes received
  • Collect co-payments and agreed fees at check in Accurately record the payment and issue a receipt to the patient
  • Be encouraging and sensitive in informing all uninsured or under insured patients that a meeting with the Financial Assistance Advisor is available to them
  • Schedules appointments according to established procedures
  • Schedules appointments according to the patient?s needs and provider availability
  • Schedule the appointment within each patient?s Primary Care team If there is no availability, refer to the team nurse for instruction on how to facilitate the patient
  • Give patient appropriate information on arrival time (10 min early for existing, 20 minutes early for new patients)
  • Ask patients to bring all insurance cards and co-pays to visit
  • Give patient appointment card if appointment made in person
  • Make reminder calls to patients as needed
  • Call patients one day prior to their scheduled appointment to remind them of the date, time and provider they will be seeing
  • Ask patients to bring all insurance cards and co-pays and referrals numbers to the visit
  • Thank patients for choosing FH and let them know that we look forward to seeing them
  • Adheres to Patent Registration policies and procedures
  • Become familiar with and follow credit and collection policies and procedures as they pertain to patient services functions
  • Become familiar with and implement any new or changed procedures and policies
  • Follow confidentiality guidelines at all times
  • Be accurate in giving the time of appointment and the provider name
  • Follow FH personnel policies and department procedures
  • Shred all papers which carry any patient information - name, MR#, etc.
  • Accurately balance grids and cash drawers
  • Verify that all transactions recorded for the week equal the amount documented on the grid
  • Report any discrepancies to the Director of Patient Services
  • Participates in quality assessment and improvement activities as requested
  • Adheres to established safety policies, procedures and precautions; identifies potential or actual unsafe situations in the environment and takes measures to rectify the situation
  • Attends all required meetings, in-services and professional trainings
  • Maintains professional competence necessary to perform job responsibilities; maintains and provides agency with records of continuing education activities
  • Serves on agency committees and in professional organizations when requested
  • Provide excellent customer service
  • Greet each client with a smile and a welcoming, professional manner
  • Answer each phone call in a cheerful and professional manner
  • Give patients clear directions to the relevant waiting area and clear instructions to wait there to be called
  • Provide clients with correct and accurate information regarding FH services and providers
  • Ask for input from team colleagues if unsure of correct response to inquiries
  • Refer unusual or difficult situations to supervisor
  • Investigate managed care inquiries with PCPs, patients, specialty offices and insurance companies
  • Actively build good working relationships with colleagues and providers
  • Meet agency participatory expectations
  • Adhere to all agency and departmental policies and procedures
  • Participate in quality assessment and improvement activities as requested
  • Adhere to the highest principles of patient and client confidentiality
  • Adhere to established safety policies, procedures and precautions; identifies potential or actual unsafe situations in the environment and take measures to rectify the situation
  • Attend all required meetings, in-services and professional trainings
  • Maintain professional competence necessary to perform job responsibilities; Maintain and provide agency with records of continuing education activities
  • Serve on agency committees and in professional organizations when requested
  • Perform other related duties as requested

We offer competitive salaries, and for those who qualify, an excellent benefits package; including comprehensive medical and dental insurance plans, and a retirement plan with employer match. We also provide 11 paid holidays, paid vacation, and more.
LGBTQ-identified persons, people of color, and others from historically underrepresented communities are encouraged to apply.


  • Minimum of high school graduate or equivalent, BA/BS preferred
  • Familiarity with state and commercial insurance
  • Knowledge of US healthcare delivery and managed care requirements preferred
  • Computer experience required, especially with electronic medical record software, billing/registration software, and Microsoft Office
  • Able to meet deadlines, follow through on assigned tasks, and attend carefully to details
  • Able to proactively reach out to team members to offer or receive help, ask or answer questions
  • Successful customer service background required; bilingual Spanish/English preferred
  • Willingness to work with diverse patient population including the GLBTQ community, seniors, students and others
  • Calm, patient and understanding manner
  • A willingness to accept changes and challenges
  • Ability to work harmoniously with diverse groups of individuals
  • Experience working in an ethnically, culturally, and racially diverse environment preferred

Physical Requirements:

  • Ability to meet the following physical requirements with or without reasonable accommodations:
  • Sit at a computer station for extended periods of time
  • Ability to keyboard for extended periods of time
Job Type Full-time