Referral Quality Coordinator

What You'll Do

Validate and Review Referral Information

• Review incoming referrals processed through AI-assisted technologies
• Verify patient demographics, insurance coverage, provider information, diagnosis details, and supporting clinical documentation
• Compare extracted information against source documents to ensure accuracy
• Classify referral documentation according to established workflow standards
• Identify incomplete, conflicting, duplicate, or inaccurate information

Ensure Referral Readiness

• Confirm referrals contain the information required for authorization and scheduling activities
• Recognize missing clinical documentation and payer-specific requirements
• Resolve routine discrepancies and escalate complex issues when appropriate
• Partner with providers, clinical teams, and internal departments to obtain missing information
• Prepare referrals for smooth progression into the authorization process

Support Quality and Operational Excellence

• Apply independent judgment when reviewing AI-generated information
• Maintain high levels of accuracy while meeting productivity standards
• Follow standardized review processes and quality expectations
• Identify recurring workflow, documentation, or technology challenges
• Contribute to process improvements and adoption of new technologies

What We're Looking For

Required Qualifications

• High school diploma or equivalent
• 2-3 years of experience in healthcare intake, patient access, prior authorization support, insurance verification, or a related healthcare operations role
• Experience working with commercial and government payers, including Medicare and Medicaid
• Knowledge of medical terminology and clinical documentation
• Familiarity with referral management, insurance verification, and authorization workflows
• Experience using EMR, practice management, or healthcare workflow systems
• Proficiency with Microsoft Outlook and Excel

Preferred Qualifications

• Associate degree in Healthcare Administration, Medical Office Management, or related field
• Experience supporting infusion services, specialty pharmacy, or buy-and-bill environments
• Familiarity with payer-specific authorization requirements across commercial and government plans

Success in This Role Looks Like

• You catch details that others miss
• You can independently validate information rather than relying solely on automated outputs
• You enjoy investigating discrepancies and finding solutions
• You balance speed with accuracy
• You stay organized while managing multiple work queues and priorities
• You communicate professionally with providers, clinical teams, and internal partners
• You adapt quickly to new systems, workflows, and technologies

Why This Role Matters

Every referral you validate helps reduce delays, improve operational efficiency, and create a better patient experience. Your work ensures patients can move through the authorization process faster and receive the care they need with fewer barriers.