Mandatory Referral Eligibility

Job Description

Job Description

The leading cardiology group in the West Valley is expanding and looking to add valuable and skilled team members to our comprehensive and long-standing Practice.

Cardiac Solutions provides a personalized, team-oriented approach to patient care by promoting wellness through education, innovation, and technology. We offer intensive educational opportunities for patients through our disease management clinics and employ a multidisciplinary approach. All team members play a vital role in providing our patients with tailored care and support services. Our focus helps to prevent the progression of heart disease and minimize hospital admissions for our patients.

• Competitive wages
• Uniform/Scrub Allowance
• Monday – Friday for most positions
• 7 Company Paid Holidays*
• Employee Medical coverage option as low as $25.00 per paycheck*
• Dental & Vision*
• Supplemental coverage options to include Life/AD&D, Short-Term, Long-Term, Critical Illness, Hospital, Accidental*
• 401(k) retirement plan
• Paid Time Off*
• Paid Sick Time
• Employee Assistance & Discount Programs

*Available to full-time, regular employees*     -     ** Restrictions may apply **

POSITION SUMMARY:

Responsible for obtaining referrals from primary care physicians (PCP) and authorizations from insurance companies for office visits, testing and hospital procedures when the plan requires authorizations. Verifies insurance and applies correct plan information in patient’s accounts. Notifies patients of out of pocket responsibility for testing and procedures. This position is typically required to work mandatory overtime January through March of each calendar year. Please note that the overtime may be changed, modified or canceled at any time with or without notice.

ESSENTIAL JOB DUTIES:

• Obtains and verifies that applicable mandatory referrals are on file.
• Verifies Primary and Secondary insurance plans.
• Verifies and updates patient registration information in the practice management system.
• Create new patient accounts for non-established patients.
• Obtains benefit verification and necessary authorizations /referrals prior to patient arrival for all visits.
• Creates appropriate referrals/cases to attach to pending visits.
• 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.
• Fax referral form to PCPs for office visits in timely fashion.
• Manages both internal and external incoming calls to the department
• Consistently seeks resources to stay informed on changing authorization requirements for testing and procedures.
• Other duties and tasks assigned as appropriate or necessary.