Job Description

We are seeking a highly detail-oriented, proactive, and experienced Bilingual Referral Coordinator to support our growing orthopedic practice. In this role, you will be the critical link ensuring patients transition smoothly from their initial referral through to physical therapy, advanced imaging, or orthopedic surgical procedures.

The ideal candidate possesses a deep administrative understanding of the insurance referral and prior authorization process, is fully bilingual in English and Spanish, and has hands-on experience in a U.S.-based medical office. Prior experience navigating the ModMed EMR platform will give you a significant advantage in this role.

Primary Responsibilities:

Referral Processing & Tracking

• Care Coordination: Process and track both incoming and outgoing referrals for orthopedic consultations, advanced imaging (MRIs, CT scans), physical therapy, and surgical procedures.
• Seamless Transitions: Coordinate directly with ordering providers, specialists, and ancillary clinical facilities to ensure medical records and referral packages are successfully received.
• Proactive Follow-ups: Systematically follow up on pending referrals and outstanding authorizations to prevent any clinical delays in patient care.

Insurance Verification & Prior Authorization

• Coverage & Eligibility: Verify patient insurance benefits and successfully obtain prior authorizations for referred orthopedic services.
• Financial Integrity: Collaborate closely with our billing team to ensure all secured authorization numbers are captured and correctly documented prior to the patient's scheduled service.
• Data Accuracy: Utilize working knowledge of CPT and ICD-10 codes to submit accurate clinical authorization requests to insurance portals.

Bilingual Patient & Provider Communication

• Call Management: Confidently handle a high volume of inbound and outbound phone calls from patients, medical providers, and insurance carriers.
• Linguistic Support: Communicate complex referral status updates and clinical requirements to patients in both fluent English and fluent Spanish.
• Patient Advocacy: Provide empathetic, clear, and professional customer service during every call to ease patient anxiety regarding their care timelines.

Requirements

Required Qualifications

• Proven Experience: Minimum 2+ years of referral coordination or medical administrative experience within a U.S.-based practice.

• Bilingual Fluency: Read, write, and speak fluently in both English and Spanish
• Insurance Savvy: Practical, working knowledge of insurance authorization workflows, medical portals, and the fundamental differences between major payer networks.
• Clinical Coding Knowledge: Familiarity with orthopedic-specific CPT and ICD-10 diagnostic codes.
• Communication & Tech Skills: Excellent written and verbal communication skills across both languages, with a highly organized approach to managing high-volume data streams.

Preferred Requirements

• Direct, hands-on software experience utilizing the ModMed (EMA) platform.
• Prior experience working specifically in Orthopedics, Spine, Sports Medicine, Pain Management, or a related musculoskeletal surgical specialty.
• Experience coordinating complex imaging authorizations (such as orthopedic MRIs or CT scans).