Before we built anything, we spent time watching intake coordinators do their jobs. Not in a structured interview setting, where people tend to describe what they think they should be doing. In the actual flow of the workday, beside them at their desks, watching what they clicked on, what they printed, what they set aside for later, and what they could not get to at all.
What we found was not what we expected from our pre-existing mental model of the role. The intake coordinator role as it actually operates at a small infusion clinic looks very different from how it is typically described in job postings or workflow diagrams. This article is an attempt to describe what we observed, because that observation is the foundation of what Coral is built to address.
The Morning Starts With the Fax Queue
At the clinics we visited, the morning typically starts between 7:30 and 8:30 AM. The first task almost always involves the fax machine or virtual fax inbox. Some clinics use physical fax machines that print overnight. Others use cloud-based virtual fax services that accumulate documents in an inbox. Either way, the coordinator's day starts with a stack of inbound documents that arrived after they left the previous evening.
The first job is sorting. Not all incoming faxes are new referrals. A typical morning queue at a clinic handling 15 to 20 referrals per week might include: new referral packets from referring physicians, authorization approval letters from payers, authorization denial letters from payers, requests for additional information from payers on pending auths, updated insurance information for existing patients, and misdirected faxes from physicians who have the wrong number. These need to be separated and routed differently.
An experienced coordinator does this sorting quickly, by learned visual pattern recognition. A new coordinator is slower and more uncertain. The sorting step takes 20 to 40 minutes in a clinic with typical overnight volume, and the pace of that step shapes everything that follows.
New Referrals Get Triaged by Urgency
Once new referrals are identified, they get a quick read to assess urgency. A patient being referred for an infusion therapy to start within 48 hours gets priority handling. A routine monthly renewal gets queued. A referral with obvious documentation gaps gets flagged as needing a callback to the referring practice before an auth can be initiated.
This triage judgment is one of the places where coordinator experience shows most clearly. An experienced coordinator can scan a referral document in 60 to 90 seconds and have a confident assessment of what it contains and what it needs. A coordinator in their first three months takes substantially longer and is less reliable in their assessment.
The coordination between this urgency triage and the rest of the day's scheduling is where some of the most important workflow friction occurs. If a priority referral lands in the queue on a day when the coordinator has three insurance verification calls already on the calendar, something gives. Usually it is the auth submission timing on the lower-priority referrals.
The Authorization Filing Block
Most coordinators try to batch their authorization filings into a focused window in the mid-morning, typically between 9 AM and 11 AM, when the phone volume from patients and referring practices is lower. This batching is a natural defensive strategy against the interruption cost of switching between the fax document reading task and responding to inbound calls.
During the filing block, the coordinator works through the queue of referrals that are ready to submit. For each one, the steps are roughly: read the referral to locate the relevant clinical fields, verify or look up any fields that are missing or unclear, open the payer's authorization portal or initiate the phone auth process, fill in the form fields, attach any required documentation, and submit.
The payer portal navigation adds its own friction. Different payers have different portals. Portal logins expire. Portal interfaces change without notice. Saved credentials stop working. One clinic we visited had a shared folder of payer portal login credentials with a sticky note system for tracking which ones had recently changed. Two coordinators at different clinics mentioned that navigating a new payer's portal for the first time on a live authorization request is among the more stressful tasks in their day, because they are learning the interface in real time while a real patient's treatment timing is at stake.
The Interruption Pattern
What the workflow diagrams do not show is how frequently the filing block gets interrupted. Patients call to check on their authorization status. Referring physicians' offices call to follow up. The clinical team asks about scheduling availability for an upcoming infusion. The manager has a question. Another fax arrives.
We tracked the interruption frequency during one coordinator's filing block at a mid-size specialty infusion practice. In a 90-minute window that was nominally protected for authorization filing, there were seven interruptions. The shortest was 45 seconds. The longest was 11 minutes. The coordinator did not complete a single authorization in a single uninterrupted block during that window. Each one was started, set aside, and returned to.
The cost of this interruption pattern is not just time lost to the interruptions themselves. It is the re-orientation cost when returning to a document mid-read. Coordinators described this consistently: when you put down a referral document halfway through to take a call, you spend two or three minutes when you return to it re-finding your place and re-reading context you had already processed. That re-orientation time compounds.
The Denial Queue That Sits Waiting
One of the more significant findings from our time with coordinators was the state of the denial queue. At two of the three clinics, there was a visible backlog of authorization denials waiting to be appealed. Not cases where appeals had been filed and were pending payer response. Cases where the denial had been received and nothing had been done yet.
The average age of those backlogged denials was 12 days at one clinic and 8 days at another. For the patients whose authorizations were in that pile, treatment start was delayed by at least those many days on top of the original authorization timeline.
The coordinators were not unaware of or indifferent to those backlogs. They described them with evident frustration. But new referrals arriving daily had to be processed first, because those patients were not yet waiting for treatment. The denial backlog competed for time with the new referral queue and was consistently losing. This is a prioritization triage problem with a clear systemic cause: the authorization filing load leaves insufficient time for denial management.
What Coordinators Find Meaningful
We asked each coordinator we spent time with what parts of their job they found most meaningful. The answers were consistent across clinics. None of them described fax document reading as meaningful. None of them described payer portal navigation as meaningful. What they described were the moments when they reached a patient who had been waiting anxiously and could tell them the authorization had come through. The conversations with referring physicians' offices where they could confirm a complicated prior auth was approved. The advocacy work when a denial came back and they could successfully appeal it.
The gap between what coordinators find meaningful and where their time actually goes is significant. We are not saying that document processing is not real work that needs doing. We are saying that it is the least distinctive thing a skilled coordinator does, and the proportion of their day consumed by it leaves less time for the work that requires their actual expertise.
That observation is the foundation of what Coral is designed to change. Not the full scope of what a coordinator does. Just the part that is pure document-to-form transcription, so that the time freed up by not doing that can go toward the work that actually benefits from a human doing it.