Medical - Referral Coordinator (On-Site)

The Referral Coordinator plays a critical role in ensuring timely, coordinated, and complete continuity of care for patients referring to outside specialists or ancillary services. This position manages all aspects of the referral process, including creation, prior authorization, scheduling, tracking, and closure—to meet clinical, operational, and compliance standards for a Federally Qualified Health Center (FQHC).

The Referral Coordinator ensures that every referral is tracked from initiation to completion (“closing the loop”), documenting all actions in the EHR and following up on outstanding specialist reports to ensure care coordination, regulatory compliance, and quality reporting requirements (e.g., UDS, HEDIS, and PCMH).

This role requires strong organizational, communication, and data management skills to maintain referral workflows, meet productivity metrics, and support the overall mission, vision, and values of SDCHC.

Essential Duties and Responsibilities:

Primary Functions:

Referral Management & Coordination

1. Receive, review, and process referrals from dental, medical, and behavioral health departments daily, ensuring accuracy and completeness of orders and supporting documentation.
2. Obtain prior authorizations from health plans when required, documenting all submissions, approvals, and denials in the EHR.

Referral Management & Coordination (continue)

1. Schedule specialist appointments for patients and confirm details with both patients and specialists.
2. Track the progress of all referrals to ensure completion and timely communication of specialist consult notes back to the referring provider (“closing the loop”).
3. Maintain ongoing communication with patients regarding referral status, providing updates on authorizations, appointment scheduling, and next steps.
4. Ensure urgent or stat referrals are prioritized and handled within defined timelines; escalate delays or barriers to the Referral Supervisor.
5. Maintain accurate referral logs, dashboards, or tracking tools to monitor referral completion rates, turnaround time, and productivity metrics.

Communication and Collaboration

1. Serve as a liaison between providers, patients, health plans and external specialists to coordinate care and resolve referral-related barriers.
2. Communicate professionally with health plans, hospitals, and partner clinics, ensuring compliance with HIPAA and confidentiality standards.
3. Provide referral process education and training to providers and staff as needed.

Documentation & Compliance

1. Accurately document all referral activity and communications in the Electronic Health Record (EHR) system (e.g., eClinicalWorks).
2. Verify patient eligibility and benefits before submitting referrals or authorizations.
3. Document required information for denial letters or non-covered services per policy.
4. Maintain compliance with federal, state, payer, and FQHC program requirements related to referrals, prior authorizations, and continuity of care.
5. Participate in quality improvement initiatives focused on referral efficiency, loop closure, and patient satisfaction.
6. Other duties as assigned.

Productivity & Performance Expectations:

1. Referrals Processed (created, tracked, updated):                        25-30 per workday.
2. Prior Authorizations Submitted:                                                  10-20 per workday
3. Specialist Appointments Scheduled:                                           10-20 per workday
4. Consult/Progress Notes Received & Attached (closed):               >50% of referrals closed within 30 days

                                                                                    25% of referrals closed within 31-45 days

                                                                                                11-15% of referrals closed within 46-90 days

                                                                                                <10% of referrals are closed >90days

1. Stat and Urgent referral processing turnaround time:                   Within 24–72 hours of referral entry
2. Patient contact attempts:                                                           Minimum 3 contacts per patient

Qualifications:

Minimum Qualifications:

1. High School diploma or GED.
2. Minimum 1 to 2 years of experience.
3. Experience working within the health care industry and with health care insurance.
4. Knowledge of and experience with medical terminology and procedural coding required; includes ability to interpret insurance information.
5. Clerical or administrative support background.

1. Knowledge of ICD-9 and CPT codes.

1. Experience with insurance plans, including Medicare and/or Medicaid, third-party payer practices and guidelines, and pre-certification and referral management for insurance plans.

Preferred:

1. Medical assisting, or other clinical degree.
2. Previous referral experience or knowledge base.

1. Experience serving a multinational, multicultural population.
2. FQHC experience.

Special Conditions of Employment:

1. CPR/ BLS certification: Maintain a current Basic Life Support (BLS) certification issued by the American Heart Association (AHA), the American Red Cross, or an equivalent organization. Certification must include an in-person, hands-on skills assessment. Online-only certifications are not accepted.
2. Annual background checks: Consent to annual background checks as a condition of continued employment, to ensure compliance with organizational standards and eligibility requirements.
3. For-Cause Drug Screening: Comply with drug screening requirements when initiated by the organization for cause, to support a safe, compliant, and drug-free workplace.
4. Ongoing Compliance Requirements: Maintain up-to-date compliance with all required annual renewals, including professional licenses, certifications, physical examinations, TB testing, and mandatory regulatory trainings as assigned by the San Diego Community Health Center (SDCHC).

Knowledge, Skills, and Abilities:

1. Excellent oral and written communication skills.
2. Excellent time management skills
3. Excellent organizational skills and attention to detail.
4. Ability to maintain confidentiality and meticulous records.
5. Effective interpersonal skills.
6. Able to deal effectively with a diversity of individuals.
7. Ability to establish and maintain cooperative working relationships with all during the course of work.
8. Bilingual in Spanish/English a plus
9. Must be reliable and extremely trustworthy. 
10. Demonstrated proficiency in Microsoft Suite or related programs. Ability to learn other accounting software systems.

Physical and Mental Requirements:

1. Able to lift/move up to 10 pounds, move from place to place.
2. Able to sit at a desk and work on a computer for prolonged periods.
3. Able to stand, bend and reach for prolonged periods.
4. Ability to do math, organize and prioritize workload, work effectively and efficiently under stress.
5. Ability to supervise, multitask, understand, and follow instructions.
6. Ability to proficiently read, write, speak, and understand English.

Customer Service:

1. Actively supports, promotes, and works to fulfill the Mission, Vision, and core values of SDCHC.
2. Provides excellent internal and external customer service.
3. Demonstrates SDCHC’s Standards of Customer Service Behavior: Compassion, Attitude, Communication, Appearance, Sense of Ownership, and Teamwork.
4. Participates in on-going customer service training.
5. In every action, seeks to promote SDCHC as a top service organization.

Quality Management:

1. Contribute to the success of the organization by participating in quality improvement activities.
2. Complies with all SDCHC policies and procedures and proactively participates in the implementation of new initiatives.
3. Participate and ensures continuous quality improvement process as directed by clinic leadership.  

Safety:

1. Ensures regulatory compliance and adherence with policies and procedures related to safe work practices.
2. Participate in infection prevention through appropriate use of infection control measures during patient treatment and patient interactions.
3. Ensure compliance with regulatory requirements for maintaining physical spaces, equipment, and supplies.  
4. Uses all appropriate equipment and/or tools to ensure workplace safety. 
5. Immediately reports unsafe working conditions. 

Privacy/Compliance:

1. Maintains privacy and security of all patients, employee, and volunteer information and access to such information. Such information is accessed on a need-to-know basis for business purposes only. 
2. Complies with all regulations regarding corporate integrity and security obligations. Reports on unethical, fraudulent, or unlawful behavior or activity.
3. Upholds strict ethical standards.

    Flexibility:

1. Available for all shifts and, when required, able to work evenings and weekends.

Disclaimer

Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time. This description reflects management’s assignment of essential functions; it does not proscribe or restrict the tasks that may be assigned. This job description is subject to change at any time.

Preference is given to qualified American Indian/Alaskan Natives in accordance with the American Indian Preference Act (Title 25, U.S. Code Section 472, 473 and 473a). In other than the above, the San Diego Community Health Center, is an equal opportunity employer.

Acknowledgement

San Diego Community Health Center is an Equal Opportunity Employer. We encourage applications from all individuals regardless of race, religion, color, sex, pregnancy, national origin, sexual orientation, gender identity, gender expression, ancestry, age, marital status, physical or mental disability or any other protected class, political affiliation, or belief.

Preference is given to qualified American Indian/Alaskan Natives in accordance with the American Indian Preference Act (Title 25, U.S. Code Section 472, 473 and 473a). In other than the above, the San Diego American Indian Health Center, is an equal opportunity employer.

San Diego American Indian Health Center is an Equal Opportunity Employer. We encourage applications from all individuals regardless of race, religion, color, sex, pregnancy, national origin, sexual orientation, gender identity, gender expression, ancestry, age, marital status, physical or mental disability or any other protected class, political affiliation, or belief.