Referral Coordinator Manager at Soni Family Practice – Aventura, Florida

Company: SFP Health Group

Job title: Referral Coordinator Manager

Division/Department: Health Services

Reports to: VP of Health Services

Job Summary:

The Referral Coordinator Manager is responsible for overseeing the referral coordination operations across SFP Health Group clinics. This role ensures that patient referrals are processed efficiently, accurately, and in compliance with payer requirements while maintaining high levels of patient satisfaction and continuity of care within the organization’s Preferred Provider Network (PPN).

The manager supervises referral coordinators, standardizes referral workflows, and ensures timely authorizations, scheduling, and documentation across all lines of business including Medicare, Medicaid, Managed Care, Commercial, and Workers’ Compensation. This position also works closely with physicians, care coordinators, case managers, and operational leadership to optimize referral processes, reduce care delays, control network leakage, and improve value-based care performance

Essential Duties and Key Responsibilities:

Referral Operations Management

• Oversee and manage daily referral operations across SFP Health Group clinics.
• Supervise and support referral coordinators to ensure accurate and timely processing of referrals.
• Monitor referral workflows, turnaround times, and authorization approvals.
• Implement standardized referral tracking processes within EMR and referral management systems.
• Ensure referrals are directed to in-network specialists whenever appropriate to support Preferred Provider Network utilization.
• Monitor referral volume and identify opportunities to reduce unnecessary referrals or overutilization.

Referral Processing & Tracking

• Ensure all provider referral requests to specialist providers and diagnostic services are received, reviewed, and processed efficiently.
• Monitor referral status and ensure appointments are scheduled in a timely manner.
• Track referral completion rates and follow up on pending or delayed referrals.
• Maintain updated records of referral statuses, authorizations, and outcomes in EMR systems.
• Oversee the development and maintenance of the SFP Health Group Preferred Provider Network list.

Team Leadership & Staff Development

• Hire, train, mentor, and evaluate referral coordination staff.
• Establish performance metrics and KPIs for referral coordinators.
• Provide ongoing training regarding payer requirements, authorization workflows, and referral policies.
• Conduct regular team meetings to address operational issues and improve processes.
• Ensure staff maintain excellent patient communication and service standards.

​Communication & Coordination

• Serve as the primary liaison between physicians, referral coordinators, care management teams, and specialists.
• Coordinate with care coordinators for surgical or complex specialty referrals.
• Work with clinic leadership to resolve referral delays or authorization challenges.
• Maintain strong relationships with internal providers and external specialists to facilitate coordinated care.

Insurance Verification & Authorization Oversight

• Ensure accurate verification of patient insurance eligibility and benefits across all lines of business.
• Monitor prior authorization requests to ensure payer compliance and timely approvals.
• Maintain knowledge of payer requirements, capitated contracts, and referral policies.
• Provide guidance to providers and staff regarding payer-specific referral rules.

Patient Experience & Support

• Ensure referral staff provide clear communication to patients regarding referral status and scheduling.
• Monitor patient satisfaction related to referral services.
• Address patient concerns or escalations related to referral delays or authorization issues.

Documentation, Compliance & Reporting

• Ensure referral documentation meets payer guidelines and internal compliance requirements.
• Maintain strict adherence to HIPAA and patient confidentiality standards.
• Generate referral performance reports including:
  • Referral turnaround time
  • Authorization approval rates
  • Network leakage metrics
  • Referral completion rates
• Work with leadership to improve referral efficiency and reduce administrative burden.

Knowledge, Skills, and Abilities:

Education & Certifications:

• High School Diploma or equivalent required
• Associate’s or Bachelor’s degree in Healthcare Administration or related field preferred, but not required.
• Certified Medical Assistant (CMA) or similar certification preferred

Experience & Technical Skills:

• Minimum 3–5 years of referral coordination experience in a primary care or managed care setting
• Minimum 1–2 years of leadership or supervisory experience preferred
• Experience with multiple payer types including Medicare, Medicaid, Managed Care, Commercial, and Workers’ Compensation
• Strong knowledge of referral authorization processes and insurance verification
• Experience with EMR systems such as Athena
• Proficiency in Excel, Availity, and referral tracking systems
• Knowledge of CPT, ICD-10, and medical terminology

Interpersonal & Professional Skills:

• Strong leadership and team management abilities
• Excellent communication and interpersonal skills
• Ability to manage multiple priorities in a fast-paced healthcare environment
• Highly organized and detail-oriented
• Strong problem-solving and decision-making skills
• Ability to maintain strict confidentiality and HIPAA compliance
• Bilingual skills are 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.

​Disclaimer - The information listed above is not comprehensive of all duties or responsibilities performed. This job description is not an employment agreement or contract. Management reserves the right to modify this job description at any time without notice.