Referral/Prior Authorization Coordinator

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. 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.

Qualifications
Behaviors
Preferred
Enthusiastic
Shows intense and eager enjoyment and interest
Dedicated
Devoted to a task or purpose with loyalty or integrity
Ability to Make an Impact
Inspired to perform well by the ability to contribute to the success of a project or the organization
Self-Starter
Inspired to perform without outside help
Experience
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
2-3 years:
Minimum two to three years of experience in a healthcare environment in a referral, front desk, or billing role.
Required
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
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.
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