Referral and Authorization Coordinator - PRN

Job Description

Job Description

Benefits :

• Competitive Health & Welfare Benefits
• Monthly $43 stipend to use toward ancillary benefits
• HSA with qualifying HDHP plans with company match
• 401k plan after 6 months of service with company match (Part-time employees included)
• Employee Assistance Program that is available 24/7 to provide support
• Employee Appreciation Days
• Employee Wellness Events

Minimum Qualifications:

• Must have Healthcare experience with Managed Care Insurance, requesting Referrals, Authorizations for Insurance, and verifying Insurance benefits.
• In-depth knowledge of insurance plan requirements for Medicaid and commercial plans.
• Minimum two to three years of experience in a healthcare environment in a referral, front desk, or billing role. Must be able to communicate effectively with physicians, patients, and the public and be capable of establishing good working relationships with both internal and external customers. Working knowledge of Centricity Practice Management and Centricity EMR is a plus.

*note this is PRN and Part time, it is not a full time role*

Essential Functions

• Verifies and updates patient registration information in the practice management system.
• Obtains benefit verification and necessary authorizations (referrals, precertification) prior to patient arrival for all ambulatory visits, procedures, injections, and radiology services
• Uses online, web-based verification systems and reviews real-time eligibility responses to ensure the accuracy of insurance eligibility.
• Creates appropriate referrals to attach to pending visits.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
• Completes chart prepping tasks daily to ensure a smooth check-in process for the patient and clinic.
• Researches all information needed to complete the registration process including obtaining information from providers, ancillary services staff, and patients.
• Fax referral forms to providers that do not require any records to be sent. Be able to process 75-80 referrals on a daily basis. For primary specialty office visits, fax referral/authorization forms to PCPs and insurance companies in a timely fashion.
• Reviews and notifies front office staff of outstanding patient balances.
• Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue goals.
• Respond to In-house provider and support staff questions, requests, and concerns regarding the status of patient referrals, care coordination, or follow-up status.
• Identifies and communicates trends and/or potential issues to the management team.
• Index referrals to patients account for existing patients.
• Create new patient accounts for non-established patients to index referrals.
• The job holder must demonstrate current competencies for the job position.