Job Description

Job Location: 415 Columbia Rd - Dorchester, MA 02125
Position Type: Full Time 30+ hours
Salary Range: $21.00 - $29.00Position Title: Lead Referral Coordinator
Department: Reception & Support Services
Hours per week: 40
Pay Range: The expected base pay for the position is $21-$29 per hour and may be increased based on other factors, such as language, certifications, etc.
Primary Function:
Under the supervision of the Practice Supervisor and direction of the Director of Operations, the Lead Referral Coordinator provides day-to-day workflow oversight of the Referral Department while also performing the functions of a Referral Coordinator.
The Lead Referral Coordinator ensures efficient, timely processing of external referrals, insurance authorizations, and appointment scheduling. This role supports quality assurance, workflow optimization, staff training and coaching, departmental performance targets as well as supports the Supervisor in resource development, trainings, staff meeting agenda development, and input to performance appraisals and plans.
The Lead Referral Coordinator serves as a resource to Referral staff, providers, and leadership to ensure referrals are processed accurately, timely, and in alignment with Standard Operating Procedures (SOPs) and payer requirements.
Duties & Responsibilities:
Lead Responsibilities:
- Assure optimal workflow and patient flow within the Referral Department.
- Monitor assigned referral work queues to ensure timely processing consistent with SOPs.
- Provide quality monitoring of referral processing, insurance authorization documentation, and scheduling accuracy.
- Provide training, coaching, and ongoing support to Referral staff regarding:
- - EMR referral workflows
- - Insurance authorization processes
- - Documentation standards
- - Customer service expectations
- Monitor productivity and performance metrics; provide feedback and identify improvement opportunities.
- Identify workflow inefficiencies and collaborate with the Practice Supervisor to implement process improvements.
- Serve as escalation point for complex or problematic referrals.
- Provide input into staff performance appraisals, corrective action, and performance improvement planning as requested.
- Assure staff maintain up-to-date payer requirements and referral guidelines.
- Attend internal and external meetings as needed to support referral operations.
- Support department readiness for audits or compliance reviews.
- Promote high standards of professionalism, teamwork, and patient-centered service delivery.
- Referral Management Responsibilities:
- Manage outgoing referrals created by providers in the EMR work queues in a timely manner.
- Coordinate and schedule external specialty and imaging appointments while verifying demographic and financial information.
- Obtain pre-authorizations from insurance carriers as required.
- Accurately document authorization numbers, number of approved visits, service type, and approved timeframes in the EMR.
- Prospectively identify patients requiring prior authorization and ensure approval prior to appointment date.
- Effectively communicate authorization outcomes to patients and referring providers.
- Troubleshoot complicated referrals to outside specialists.
- Investigate billing issues related to specialty/imaging referrals and advocate for patients with insurance carriers when necessary.
- Maintain updated contact lists for:
- - External specialty/imaging practices
- - Insurance provider relations contacts
- Verify third-party insurance eligibility as needed.
- Facilitate urgent appointment requests when clinically appropriate.
Scheduling Responsibilities:
- Schedule external specialty/imaging appointments according to external organization protocols.
- Identify patient availability prior to scheduling.
- Register patients with external organizations when required.
- Respond to patient inquiries regarding referral appointment dates and status.
- Reschedule patients from canceled appointments as necessary.
- Maintain accurate scheduling records and documentation.
Other Support Duties:
- Handle telephone calls courteously and professionally.
- Respond to inquiries from patients, providers, insurers, and external offices.
- Fax or securely transmit referrals and insurance notifications.
- Notify supervisor of operational problems in a timely manner.
- Provide cross-coverage to other areas as directed.
- Communicate effectively with all members of staff.
- Maintain strict confidentiality and HIPAA compliance.
- Perform other duties as assigned.

QualificationsBasic Knowledge:
- High school diploma or GED; some college preferred.
- EPIC/OCHIN proficiency required.
- Familiarity with medical terminology.
- Basic computer skills including Microsoft Office Suite.
- Ability to read/write fluent English.
- Bilingual (Spanish and/or Cape Verde Creole) preferred.
- Ability to maintain confidentially in regards to Protected Health Information (PHI) and maintain HIPAA compliance for the organization
- Bilingual or trilingual (Spanish or Portuguese Creole and English)
Experience &

Qualifications:
- Minimum of two to three (2-3) years’ experience working as a Referral Coordinator
- Minimum of two to five (5) years’ experience working in a direct customer service role
- Manages escalated patient and complex referral issues
- Knowledge of Insurances and obtaining insurance authorization number(s)
- Judgement and input around staff performance and corrective action
- Proven ability to make recommendations to workflow improvements and protocols that benefits the patients and health center operations
- Ability to work with persons with disabilities and seniors
- Demonstrated oral and written communication/documentation skills
- Language capabilities strongly preferred
- Experience working in a fast-paced, diverse environment
- Experience and demonstrated proficiency in computer systems and PC-based software.
- Excellent customer service skills
- Excellent verbal and written communication skills with ability to communicate effectively with individuals at all levels of organization and outside the organization
- Ability to analyze and research problems in order to develop a course of action
- Effective planning and priority setting. Ability to manage several complex projects while working under pressure to meet deadlines
- Strong organizational and planning skills
- Ability to be accurate, concise, and detail oriented
- Strong presentation skills in group and individual setting
- Ability to understand, evaluate and prioritize Benefit project/proposals
- Ability to use two + computer systems at the same time
- Experience working in a fast-paced, diverse environment
- Experience and demonstrated proficiency in computer systems, and PC- based software such as Virtual Gateway, Epic/OCHIN
- Ability to work with persons with disabilities and seniors
- Ability to work effectively within a team.
Independent Action:
Performs duties independently within established departmental policies and SOPs; escalates complex issues to Practice Supervisor when appropriate.
Supervisory Responsibility:
Leadership and coaching only
Provides functional leadership, workflow oversight, and performance input for Referral staff. Does not have direct hiring/corrective action authority.
Define Access Level to PHI:
Level 2: Authorized to access patient demographic data with only minimal reference to treatment or diagnostic information as needed to function.  Staff in this category level should confine the use of PHI to the minimum necessary required and should not access or read parts of the medical record not needed to perform assigned duties.