Referral Coordinator in Worcester, Massachusetts at Mass Lung & Allergy PC

POSITION SUMMARY
As a Referral Coordinator at Mass Lung & Allergy (MLA), this position performs a variety of duties in a manner that emphasizes quality patient care and exceptional customer service. The Referral Coordinator is responsible for coordinating patient referrals, obtaining required authorizations, and facilitating communication between patients, providers, insurance companies, and healthcare facilities to ensure timely continuity of care. The incumbent must work collaboratively with all staff in support of patient services while exemplifying the mission and core values of the organization.

DUTIES AND RESPONSIBILITIES:
• Receive, process, and track patient referrals from fax.
• Verify patient demographics, insurance coverage, and referral requirements.
• Obtain prior authorizations and insurance approvals as required.
• Schedule appointments with specialists, hospitals, imaging centers, and other healthcare providers.
• Communicate referral status and appointment details to patients and referring providers.
• Follow up on pending referrals, authorizations, and specialist reports.
• Maintain accurate referral documentation within the electronic medical record (EMR) system.
• Ensure referrals comply with payer guidelines and organizational policies.
• Resolve referral-related issues, denials, and authorization discrepancies.
• Request and obtain consultation notes, test results, and treatment recommendations from referred providers.
• Maintain confidentiality of patient information in accordance with HIPAA regulations.
• Collaborate with clinical, billing, and administrative staff to support patient care and workflow efficiency.

QUALIFICATIONS:
• High school diploma or equivalent required; associate degree preferred.
• Minimum 1–2 years of healthcare, medical office, or referral coordination experience preferred.
• Knowledge of medical terminology, insurance plans, and prior authorization processes.
• Experience with EMR/EHR systems and Microsoft Office applications.
• Strong organizational, multitasking, and time-management skills.
• Excellent verbal and written communication skills.
• Ability to work independently and collaboratively in a fast-paced environment.

PHYSICAL REQUIREMENTS:
• Ability to sit for extended periods and work at a computer.
• Occasional standing, walking, and lifting of office materials up to 15 pounds.
• Manual dexterity to operate office equipment and computer systems.