Referral Coordinator Manager

Company: SFP Health GroupJob title: Referral Coordinator ManagerDivision/Department: Health ServicesReports to: VP of Health ServicesJob 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 performanceEssential Duties and Key Responsibilities: Referral Operations ManagementOversee 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 & TrackingEnsure 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 DevelopmentHire, 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 & CoordinationServe 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 OversightEnsure 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 & SupportEnsure 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 & ReportingEnsure 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 timeAuthorization approval ratesNetwork leakage metricsReferral completion ratesWork with leadership to improve referral efficiency and reduce administrative burden.Knowledge, Skills, and Abilities:Education & Certifications:High School Diploma or equivalent requiredAssociate's or Bachelor's degree in Healthcare Administration or related field preferred, but not required. Certified Medical Assistant (CMA) or similar certification preferredExperience & Technical Skills:Minimum 3-5 years of referral coordination experience in a primary care or managed care settingMinimum 1-2 years of leadership or supervisory experience preferredExperience with multiple payer types including Medicare, Medicaid, Managed Care, Commercial, and Workers' CompensationStrong knowledge of referral authorization processes and insurance verificationExperience with EMR systems such as AthenaProficiency in Excel, Availity, and referral tracking systemsKnowledge of CPT, ICD-10, and medical terminologyInterpersonal & Professional Skills:Strong leadership and team management abilitiesExcellent communication and interpersonal skillsAbility to manage multiple priorities in a fast-paced healthcare environmentHighly organized and detail-orientedStrong problem-solving and decision-making skillsAbility to maintain strict confidentiality and HIPAA complianceBilingual skills are a plusPhysical & 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.

Created: 2026-04-02