Insurance and Referral Coordinator

Greater Austin Allergy • Corpus Christie, TX

5d

About The Position

The Insurance and Referral Coordinator manages insurance verifications and patient referrals for all Austin clinics. The role ensures accurate insurance information, verifies coverage, and coordinates referrals among healthcare providers, patients, and insurance companies. It supports clinic operations by facilitating efficient processes, securing timely approvals, and addressing insurance-related concerns to enhance patient care and streamline workflows.

The coordinator collects and enters patient demographic, insurance, and clinical information; verifies eligibility, coverage, and financial details; and communicates cost estimates and insurance information to Patient Care Representatives. The role also administers insurance portal access and responds to insurance-related inquiries while maintaining confidentiality and compliance with HIPAA and organizational policies.

For referrals, the coordinator assembles and shares clinical information, obtains required prior approvals, serves as the primary point of contact, and coordinates referral requests, renewals, details, and communications. The role monitors expiration dates and visit allotments, manages medical record requests in collaboration with ScanStat, helps resolve scheduling issues, contributes to referral procedures and materials, and ensures complete information is sent to referred specialists.

Requirements

• Expertise with operational systems, including EMRs and healthcare and administrative software such as Rosch and AdvancedMD, as well as scheduling, payroll, billing, and Google Workspace.
• Strong interpersonal and communication skills for working with physicians, medical professionals, office personnel, insurance companies, and patients.
• Ability to multitask, prioritize tasks, and manage referrals and administrative responsibilities accurately and efficiently.
• High accuracy when reviewing clinical data, patient information, insurance details, and referral documentation.
• Familiarity with referral guidelines and prior approval requirements, and ability to navigate and troubleshoot referral-related issues.
• Ability to adapt to changing workflows, regulatory requirements, and office procedures while maintaining focus on patient care and operational goals.
• Strong collaboration skills when working with colleagues, referral personnel, insurance companies, and healthcare providers.
• Commitment to supporting patient care through effective insurance verification, referral management, and documentation.

Responsibilities

• Collect and enter accurate patient demographic, insurance, and clinical information before appointments.
• Verify insurance eligibility, coverage, and financial details using online platforms or by contacting carriers.
• Analyze deductibles, copays, and coverage levels and provide financial information to Patient Care Representatives.
• Generate cost estimates and communicate them to Patient Care Representatives for distribution to front-end departments.
• Serve as the primary administrator for insurance portals and review access requests for approval or denial.
• Navigate and manage insurance portals to obtain available insurance details.
• Respond promptly and professionally to insurance-related inquiries from patients and healthcare providers.
• Stay current on insurance regulations, policies, and procedures and maintain compliance with industry standards.
• Maintain confidentiality in accordance with HIPAA guidelines and follow relevant GAA policies and practices.
• Assemble patient clinical background and referral needs and provide necessary medical data to PCPs, insurance companies, and referring providers according to referral guidelines.
• Review insurance company and organizational requirements and present medical history, diagnosis, and prognosis to secure prior approvals.
• Serve as the primary point of contact for referrals, navigating systems and assisting patients and coworkers with referrals, including VA and commercial referrals.
• Follow standardized referral policies and workflows, prioritizing referrals according to urgency.
• Coordinate referral activities, including requesting new or renewed referrals and verifying details with providers and patients.
• Monitor referral expiration dates and visit allotments to maintain current referrals.
• Manage and respond to incoming and outgoing medical record requests in collaboration with ScanStat.
• Coordinate with front-end departments to resolve scheduling issues and reschedule appointments as needed.
• Participate in developing and updating organizational referral procedures, forms, and manuals.
• Review referral details and expectations with ordering providers and patients.
• Ensure complete demographic, insurance, and clinical information is sent to referred specialists.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed