Job Description

Join to apply for the Referral Coordinator role at Apex Systems Job #: 3010159 Base Pay Range $24.00/hr - $24.00/hr Job Summary Under direct supervision, the Referral Coordinator analyzes, reviews, and processes referrals for authorization of outside medical services. The role involves handling specific referral types and specialties, following established protocols, seeking supervisory guidance as needed, researching and resolving inquiries from providers, members, and staff, updating authorizations in the system, and contributing to process improvements that enhance service levels and operational efficiency. Physical Requirements Requires lifting or short‑distance transport up to 20 pounds. Major Responsibilities & Essential Functions Referral Processing – 70% Review, evaluate, and process outside medical service referrals for completeness, accuracy, and timeliness. Determine appropriate coverage, service codes, and providers. Obtain necessary approvals and issue notifications. Customer Service & Coordination – 15% Process referrals for specific procedures and providers per policy. Conduct report reviews and corrections. Respond to inquiries from patients, providers, and case managers. Collaborate with clinical teams to ensure timely and accurate authorizations. Follow up with referring providers when information is incomplete. Contract & Claims Support – 15% Confirm outside provider agreements and request letters of payment when needed. Accurately code referrals to reflect special claims handling requirements. Job Qualifications Minimum Education Associate’s degree or two (2) years of directly related experience in accounting or a related field. High School Diploma or GED required. Preferred Education Bachelor’s degree preferred. Minimum Experience & Skills Ability to lift and transport up to 20 pounds. Experience in medical assistance, utilization management, authorization, or coding in a hospital or clinic setting. Familiarity with health information systems or medical records databases. Knowledge of medical terminology and coding. Strong customer service, phone communication, and problem‑solving skills. Ability to prioritize tasks in a high‑volume, fast‑paced environment. Must be able to work in a Labor/Management Partnership environment. Preferred Experience Familiarity with Medicare, Medi‑Cal, and KFHP benefits. Understanding of medical procedures and terminology. Seniority Level Entry level Employment Type Contract Job Function Health Care Provider Industry IT Services and IT Consulting Equal Opportunity Employer Apex Systems is an equal opportunity employer. We do not discriminate or allow discrimination on the basis of race, color, religion, creed, sex (including pregnancy, childbirth, breastfeeding, or related medical conditions), age, sexual orientation, gender identity, national origin, ancestry, citizenship, genetic information, registered domestic partner status, marital status, disability, status as a crime victim, protected veteran status, political affiliation, union membership, or any other characteristic protected by law. Apex will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law. #J-18808-Ljbffr

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