Referral Quality Coordinator

At IVX Health, every patient journey starts with a referral. Before prior authorizations can be obtained and treatment can begin, that referral must be accurate, complete, and ready to move through the process without delay. As a Referral Quality Coordinator, you'll serve as the first quality checkpoint in our referral intake process. Using AI-assisted technology and healthcare systems, you'll review referral information, validate documentation, identify gaps or discrepancies, and ensure referrals are ready for efficient progression into Prior Authorization. This role is ideal for someone who enjoys solving puzzles, investigating details, and taking ownership of accuracy. You'll combine healthcare experience, payer knowledge, and critical thinking to catch issues before they become delays for patients and providers.

Responsibilities

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; 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; 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

Requirements

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

Nice to have

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

Benefits

Medical, Dental, and Vision Coverage; Prescription Drug Coverage and Telemedicine Services; Health Savings Account (HSA), Health Reimbursement Arrangement (HRA), and Flexible Spending Options; 401(k) Retirement Plan with Company Match; Life, AD&D, and Disability Insurance; Accident, Critical Illness, and Hospital Indemnity Coverage; Fertility and Family Planning Support; Tuition Reimbursement and Certification Assistance; Continuing Education and Professional Development Resources; Employee Assistance Program and Wellness Support; Paid Time Off; Volunteer Time Off and Charitable Giving Match; Employee Referral Bonus Program