Bilingual Referral Coordinator

We are seeking a high-volume, precision-focused Virtual GI Referral Coordinator to manage the end-to-end procedural pipeline for a busy Gastroenterology practice. This role is responsible for processing medical referrals for specialized GI procedures (such as colonoscopies and endoscopies), navigating strict insurance grids, and ensuring patients are fully cleared and prepared for their upcoming procedures.

This position demands an immediate, expert-level fluency in Athenahealth EMR and a solid foundation in Gastroenterology workflows.

You will spend your day handling a fast-paced queue of 25 to 30 referrals daily, which requires high-volume inbound/outbound phone calls, submitting strict HMO prior authorizations, and flawlessly coordinating care packets between our practice, outside surgical centers, and patients. **Core Responsibilities

High-Volume Referral & HMO Prior Authorization Management**

• Referral Pipeline Execution: Efficiently process, track, and close a high-volume workflow of 25–30 specialized GI referrals per day.

• Strict HMO Code Submission: Review clinical chart notes to extract and submit correct CPT and ICD-10 diagnostic codes to strict HMO and PPO insurance plans for procedural prior authorization.

• Insurance Navigation: Aggressively follow up with insurance medical directors and utilization management lines to ensure timely approval, mitigating any surgical delays.

Comprehensive Procedure & Care Coordination

• Surgical Packet Dispatch: Compile and send out highly detailed clinical and preparation packets to both the outpatient surgery centers and the patients.

• Pre-Procedure Patient Preparation: Conduct outbound calls to patients to explain scheduling logistics, verify demographic details, and confirm they have received their vital GI procedure preparation instructions.

• Inbound Queue Support: Answer inbound provider, insurance, and patient inquiries regarding authorization status, scheduling updates, and referral pathways.

Athenahealth Grid Management

• Precision EMR Workflow: Maintain flawless data entry and tracking within the Athenahealth system, attaching confirmed insurance approval numbers, clinical documentation, and scheduling logs directly to the patient's electronic file.

Requirements

Required Qualifications (Non-Negotiable)

• Software Fluency: Minimum 1–2+ years of direct, hands-on administrative experience using Athenahealth EMR. Candidates without Athenahealth experience will not be considered.

• Prior Authorization Competency: Proven experience submitting clinical data to insurance portals, specifically managing the rigid requirements of HMO referrals.

• High-Volume Capability: Documented experience handling a fast-paced environment with a target metric of managing 25+ medical referrals daily.

• Communication & Presence: Exceptional verbal and written communication skills with a clear, professional, and confident phone presence. (Open to native English speakers and highly articulate bilingual PH-based talent).

• Remote Ecosystem: A distraction-free home office setup compliant with HIPAA privacy laws, utilizing high-speed internet and a mandatory automated hourly time-tracker.

Highly Preferred Experience

• Direct, prior experience working within a Gastroenterology (GI), general surgery, or internal medicine practice.

• Fluency in medical terminology related to endoscopic and colonoscopy procedures, diagnostic codes, and clear liquid diet workflows.