Medical Referral Coordinator

Referral, Benefits Coordinator — Physician Practice

Multi-location nephrology physician group serving hospitals, dialysis units, and outpatient clinics

Position Summary

The Referral Coordinator / Benefits Verification Specialist manages the intake, tracking, and processing of patient referrals from PCPs and other referring offices. The Coordinator works closely with the Scheduler to obtain referrals, authorizations, and verifies benefits, including copays, coinsurances, and deductibles. This role also manages the recurring monthly referral requirement that certain commercial insurance plans impose for dialysis patients. Hospital-related information (discharge summaries, notes, labs, imaging) is gathered through hospital portals — direct phone or in-person communication with hospital staff is not required. The practice does not receive referrals from hospitals or dialysis units; it does receive patients in its outpatient clinics for post-discharge follow-up.

Key Responsibilities

Referral Coordination

• Request, receive, review, and process incoming referrals from PCPs and other referring specialists via fax, EHR referral queue, phone, and secure email. (The practice does not receive referrals from hospitals or dialysis units.)
• Verify referral completeness and follow up with referring offices for missing information as needed.
• Triage referrals by urgency (e.g., new CKD diagnosis, dialysis access issues) and route to the appropriate provider/location.
• Coordinate with the Scheduler outpatient clinic follow-up appointments for recently discharged patients, and new patient and follow-up appointments generally across multiple clinic sites.
• Manage the recurring monthly referral requirement imposed by certain commercial insurance plans for dialysis patients: track which patients require a monthly referral, obtain/submit the referral before it lapses, and confirm receipt/approval so dialysis services remain covered without interruption.
• Coordinate with dialysis unit staff (social workers, charge nurses, medical directors) regarding shared patients and monthly referral needs.
• Maintain accurate referral status tracking in the EHR/referral management system, including a recurring tracker for monthly commercial insurance dialysis referrals; document all communications and follow-ups.
• Send referral confirmations and appointment details to referring providers and patients.
• Identify and escalate referrals that cannot be scheduled or authorized within target timeframes (e.g., a monthly dialysis referral at risk of lapsing, urgent new CKD diagnosis, transplant evaluation).

Benefits Verification

• Verify patient insurance eligibility and benefits (commercial, Medicare, Medicare Advantage, Medicaid, and secondary payers) prior to scheduled appointments, procedures, and dialysis-related services.
• Confirm coverage specifics relevant to nephrology care: office visits, in-office procedures, dialysis access procedures, lab work, imaging, and durable medical equipment.
• Identify and initiate prior authorization requirements for procedures, imaging, and specialty medications; track authorization status to resolution.
• Verify which dialysis patients are enrolled in commercial insurance plans requiring a monthly referral, and confirm each monthly referral is submitted and approved on schedule so coverage is not interrupted.
• Access hospital and payer portals to confirm coverage and authorization status for patients seen in hospital or dialysis settings.
• Communicate coverage details, patient financial responsibility (copays, deductibles, coinsurance), and authorization status to front-desk staff, providers, and patients prior to service.
• Document verification and authorization outcomes accurately in the EHR/practice management system.
• Flag coverage gaps, inactive policies, or non-covered services proactively, and work with patients or referring offices to resolve discrepancies before the date of service.
• Stay current on payer-specific policies affecting nephrology and dialysis services, including ESRD Medicare coordination-of-benefits rules.
• Assist with resolving eligibility-related claim denials in coordination with the billing team.
• Maintain payer contact lists and reference guides for authorization requirements across all locations and insurance plans.

Reporting

• Support monthly/quarterly reporting on referral volume, scheduling turnaround time, verification turnaround time, and no-show/leakage rates.

Qualifications

• High school diploma required.
• 2+ years of experience in medical office referral coordination, scheduling, and/or insurance verification.
• Comfortable navigating multiple hospital and payer portals to independently retrieve clinical documentation and coverage information.
• Familiarity with EHR/practice management systems (e.g., Epic, Athenahealth, NextGen, eClinicalWorks) and referral management workflows.
• Working knowledge of Medicare (including ESRD-specific rules), Medicaid, and commercial payer eligibility processes.
• Understanding of medical terminology, particularly related to nephrology, dialysis, and hospital discharge processes.
• Strong organizational skills and ability to manage a high volume of referrals and verifications across multiple sites simultaneously.
• Excellent written communication skills; comfortable liaising with dialysis unit staff and referring offices (hospital communication is portal-based, not direct contact).
• Detail-oriented with strong follow-through and ability to prioritize urgent clinical referrals appropriately.

Working Conditions

• Heavy use of hospital portals, payer portals, EHR systems, and fax/secure email for information gathering — no direct phone contact with hospital staff required.
• Requires reliable, recurring monthly tracking to keep commercial insurance dialysis referrals current and avoid coverage gaps.
• Regular communication with dialysis unit staff and referring offices (PCPs and other specialists).

North Texas Kidney Consultants was founded in 2005. The four physicians who founded the practice had a goal to provide comprehensive kidney care, with an emphasis on providing quality treatment and education on kidney disease.

North Texas Kidney Consultants has come a long way since 2005. The practice has grown from one clinic location to six locations in a short period of time. At NTKC’s inception, the physicians had privileges at one hospital. Today, NTKC’s physicians have privileges at 21 hospitals across the DFW Metroplex. The practice has added physicians and staff as part of its mission to reach more patients and provide excellent care.

North Texas Kidney Consultants is an established, growing practice, with an unwavering commitment to providing comprehensive kidney care.