Referral and Authorization Coordinator

Job Title

ESSENTIAL FUNCTIONS

• Verifies and updates patient registration information in the practice management system.
• Obtains benefit verification and necessary authorizations (referrals, precertification) before 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 accuracy of insurance eligibility.
• 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.
• 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.
• Assist in training new team members as directed
• Maintain current knowledge of payer authorization requirements across commercial, Medicare, Medicaid, and managed care plans.
• Communicate with physician offices, patients, and payers to ensure all necessary authorizations are in place prior to the date of service.
• Document all payer communications, authorization status, and outcomes in the electronic medical record (EMR) or patient account system.
• Collaborate with clinical, registration, and billing staff to avoid service delays and ensure clean claim submission.

EDUCATION

• High school diploma/GED or equivalent working knowledge preferred.

EXPERIENCE

• 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 a plus.

REQUIREMENTS

• Must have healthcare experience with managed care insurances, requesting referrals, authorizations for insurances, and verifying insurance benefits.
• In-depth knowledge of insurance plan requirements for Medicaid and commercial plans.

KNOWLEDGE

• Working knowledge of eligibility verification and prior authorizations for payment from various HMOs, PPOs, commercial payers, and other funding sources.
• Knowledge of government provisions and billing guidelines including Coordination of Benefits.
• Advanced computer knowledge, including Window based programs.

SKILLS

• Skilled in defusing difficult situations and able to be consistently pleasant and helpful.
• Skill in using computer programs and applications.
• Skill in establishing good working relationships with both internal and external customers.

ABILITIES

• Ability to multi-task in a fast-paced environment.
• Must be detailed oriented with strong organizational skills.
• Ability to understand patient demographic information and determine insurance eligibility.
• Ability to type a minimum of 45 wpm.

ENVIRONMENTAL WORKING CONDITIONS

• Normal office environment

PHYSICAL/MENTAL DEMANDS

• Requires sitting and standing associated with a normal office environment.
• Some bending and stretching are required.
• Manual dexterity using a calculator and computer keyboard.

ORGANIZATIONAL REQUIREMENTS

• HOPCo Mission, Vision, and Values must be acknowledged and adhered to

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.