Referral and Authorization Coordinator
About The Position
Supporting CISH (Core Institute Specialty Hospital) and Elevation Surgery centers, this role is responsible for verifying and updating patient registration information, obtaining benefit verification, and securing necessary authorizations (referrals, precertification) prior to patient appointments. The coordinator will utilize online systems to ensure accuracy of insurance eligibility, create appropriate referrals, and verify patient demographic and insurance information, including coordination of benefits. Daily tasks include chart prepping, researching registration information, faxing referral forms, and reviewing outstanding patient balances. The role requires maintaining productivity rates, responding to inquiries regarding referral status, and identifying potential issues for management. Additionally, the coordinator will index referrals to patient accounts and create new accounts for non-established patients.
Requirements
- Healthcare experience with Managed Care Insurance
- Experience requesting Referrals
- Experience requesting Authorizations for Insurance
- Experience verifying Insurance benefits
- In-depth knowledge on insurance plan requirements for Medicaid and commercial plans
- Minimum two to three years of experience in a healthcare environment
- Prior authorization experience
Responsibilities
- 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 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 smooth check-in process for the patient and clinic.
- Researches all information needed to complete 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 on a daily basis.
- For primary specialty office visits, fax referral/authorization form 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 management team.
- Index referrals to patient accounts for existing patients.
- Create new patient accounts for non-established patients to index referrals.
- Demonstrate current competencies for job position.
Benefits
- Salary $18-20
- Competitive Health & 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
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
