The Insurance and Referral Coordinator manages insurance verifications and patient referrals for
all Austin clinics. This role ensures accurate insurance information, verifies coverage, and
coordinates referrals with healthcare providers, patients, and insurance companies. The
coordinator supports overall clinic operations by facilitating efficient processes, ensuring timely
approvals, and addressing insurance-related concerns to enhance patient care and streamline
workflows.

JOB RESPONSIBILITIES

Insurance Verification

• Ensure accurate patient registration by collecting and inputting demographic, insurance, and
clinical information prior to appointments.
• Verify insurance eligibility, coverage, and financial details by utilizing online platforms or
contacting carriers directly.
• Analyze patient insurance details (e.g., deductibles, copays, coverage levels) and provide
transparent financial information to Patient Care Representatives.
• Generate cost estimates and communicate them to Patient Care Representatives for
dissemination to front-end departments.
• Act as Primary Administrator for insurance portals, reviewing and approving/denying
requested access.
• Actively navigate and manage multiple insurance portals to obtain available insurance details.
• Provide excellent customer service to patients and healthcare providers, addressing
insurance-related inquiries promptly and professionally.
• Stay updated on insurance regulations, policies, and procedures to ensure compliance with
industry standards.
• Maintain strict confidentiality in accordance with HIPAA guidelines and adhere to all relevant
GAA policies and practices.

Referrals

• Assemble patient clinical background and referral needs, providing necessary medical data
to PCPs, insurance companies, and referring providers according to referral guidelines.

• Review insurance companies and organizations to meet prior approval requirements,
presenting medical history, diagnosis, and prognosis to secure approvals.
• Act as the primary point of contact for referrals, navigating systems and assisting patients
and coworkers with necessary referrals (e.g., VA, Commercial).
• Follow standardized referral policies and workflows, prioritizing and addressing referrals
based on urgency.
• Coordinate referral activities, including requesting new or renewed referrals, verifying referral
details with providers and patients, and ensuring proper communication.
• Monitor referral expiration dates and visit allotments to maintain current referrals.
• Manage and respond to incoming and outgoing medical record requests in collaboration with
ScanStat.
• Coordinate with front-end departments to resolve scheduling issues and reschedule
appointments as necessary.
• Participate in the development and update of organizational procedures, forms, and manuals
related to referrals.
• Review referral details and expectations with ordering providers and patients.
• Ensure that complete demographic, insurance, and clinical information is sent to referred
specialists.

KNOWLEDGE, SKILLS & ABILITIES

• Expertise in diverse operational systems, including EMRs, healthcare and administrative
software (e.g., Rosch, AdvancedMD), scheduling, payroll, billing, and Google Workspace.
• Strong interpersonal and communication skills to collaborate with physicians, medical
professionals, office personnel, insurance companies, and patients.
• Excellent at multitasking, prioritizing tasks, and ensuring accurate, efficient management of
both referrals and administrative responsibilities.
• High level of accuracy in reviewing clinical data, patient information, insurance details, and
referral documentation, ensuring precision in all aspects of work.
• Familiarity with referral guidelines, prior approval requirements, and the ability to navigate and
troubleshoot referral-related issues efficiently.
• Ability to adapt to changing workflows, regulatory requirements, and evolving office
procedures while maintaining focus on patient care and operational goals.
• Strong collaboration skills to work effectively with colleagues, referral personnel, insurance
companies, and healthcare providers in a cohesive and efficient manner.
• Dedicated to ensuring patients receive the best care by effectively managing their insurance
verification, referrals, and all associated documentation.