[Hiring] Referral and Authorization Coordinator I @Healthcare Outcomes Performance Co. (HOPCo)

Role Description

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; 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.
• Responds 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.
• Indexes referrals to patients account for existing patients.
• Creates new patient accounts for non-established patients to index referrals.
• Assists in training new team members as directed.
• Maintains current knowledge of payer authorization requirements across commercial, Medicare, Medicaid, and managed care plans.
• Communicates with physician offices, patients, and payers to ensure all necessary authorizations are in place prior to the date of service.
• Documents all payer communications, authorization status, and outcomes in the electronic medical record (EMR) or patient account system.
• Collaborates with clinical, registration, and billing staff to avoid service delays and ensure clean claim submission.

Qualifications

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