Referral and Authorization Coordinator - PRN

Job Title

PRN and Part Time Healthcare Position

Benefits

Competitive health and 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

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.

HOPCo | Healthcare Outcomes Performance Company