Primary Care - Lead Referral Coordinator

Company: SFP Health Group

Job title: Lead Referral Coordinator – Primary Care

Division/Department: Health Services

Reports to: VP Health Services

Job Summary: 

The Referral Coordinator Lead oversees the daily operations of the referral department, ensuring all patient referrals are processed accurately, efficiently, and in compliance with payer guidelines. Acting as the primary liaison between providers, patients, insurance companies, and referral staff, this position ensures patients remain within the network and under the PPN to improve satisfaction and reduce overutilization. The Manager is responsible for supervising and training Referral Coordinators, maintaining workflows for all lines of business (Medicare, Medicaid, Managed Care, Commercial, Workers’ Compensation), and implementing process improvements to enhance service quality and timeliness.

Essential Duties and Responsibilities: 

Leadership & Team Management

• Supervise daily activities of Referral Coordinators, assigning workload and monitoring performance.
• Train, mentor, and evaluate staff to ensure compliance with policies and payer requirements.
• Conduct regular team meetings to review referral status, address challenges, and communicate updates.
• Develop and maintain department performance metrics to monitor productivity and accuracy.

Referral Process Oversight

• Ensure all patient referrals to specialists, diagnostic centers, and other services are processed timely and accurately.
• Oversee scheduling of patient appointments and confirm receipt of referrals with external providers.
• Monitor follow-ups with patients and healthcare providers to ensure timely delivery of care.
• Create and Maintain the SFP Health Group Preferred Provider Network and ensure staff use in-network providers whenever possible.

Insurance & Authorization Management

• Oversee verification of patient insurance eligibility, coverage, and benefits for referred services across all lines of business.
• Ensure prior authorization requirements are met by coordinating with staff and contacting insurance companies when necessary.
• Review and approve referral documentation to meet payer-specific criteria before submission.
• Maintain up-to-date knowledge of insurance plans, capitations, and communicate changes to staff and providers.

Collaboration & Communication

• Serve as the main point of contact between the referral department, providers, Care Coordinators, and office management.
• Partner with the Care Management team on surgical requests and complex referral cases.
• Establish and maintain positive working relationships with physicians, MAs, nurses, and office staff at SPF Health Group.
• Communicate with patients regarding referral processes, appointment expectations, and insurance requirements when escalations occur.
• During periods of high referral volume, assist team members in processing referrals to maintain timeliness and quality of service.

Compliance & Quality Assurance

• Monitor adherence to HIPAA regulations and ensure patient confidentiality is maintained at all times.
• Conduct periodic audits of referral logs, EMR documentation, and prior authorizations to ensure accuracy and compliance.
• Identify bottlenecks or delays in the referral process and implement workflow improvements.
• Provide reports to leadership on referral trends, turnaround times, and departmental performance.

Knowledge, Skills, and Abilities:

Education & Certifications:

• High School Diploma or equivalent required
• Certified Medical Assistant (CMA) preferred.

Experience & Technical Skills:

• Minimum 3–5 years of referral coordination experience in a primary care or multi-specialty healthcare setting, with at least 1–2 years in a supervisory or lead role.
• Experience managing referrals for all lines of business (Medicare, Medicaid, Managed Care, Commercial, Workers’ Compensation).
• Proficient in Excel and Availity.
• Knowledge of Athena and other EMR systems.
• Strong knowledge of CPT, ICD-10, and medical terminology.

Leadership & Interpersonal Skills:

• Strong leadership, team-building, and coaching abilities.
• Excellent interpersonal and communication skills, with the ability to handle escalated patient concerns.
• Must be detail-oriented, organized, and able to manage multiple priorities in a fast-paced environment.
• Knowledge of patient care and examination procedures.
• Bilingual is a plus.

Physical & Mental Requirements: (check all that apply)

 Ability to stand or sit for extended periods of time.

 Ability to receive and comprehend instructions verbally and/or in writing.

 Ability to use logical reasoning for simple and complex problem solving.

 Occasionally requires exposure to communicable diseases or bodily fluids.

 Occasional travel for clinical activities may be required. 

The information listed above is not comprehensive of all duties/responsibilities performed. This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice.

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