Referral 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.

· 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 form to providers that do not require any records to be sent. Be able to process 75-80 referrals daily. 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.

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.

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.