Referral and Authorization Coordinator

Healthcare Outcomes Performance Co. (HOPCo) • Phoenix, AZ

1d • $18 - $20

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 necessary authorizations (referrals, precertification) prior to patient arrival for all ambulatory visits, procedures, injections, and radiology services. The coordinator will utilize online, web-based verification systems and review real-time eligibility responses to ensure accuracy of insurance eligibility. They will also create appropriate referrals to attach to pending visits, verify patient demographic information and insurance eligibility including coordination of benefits, and update as necessary to allow processing of claims to insurance plans. Daily chart prepping tasks are essential for a smooth check-in process. The role involves researching all information needed to complete the registration process, including obtaining information from providers, ancillary services staff, and patients. A key responsibility is faxing referral forms to providers, processing an estimated 75-80 referrals daily, and for primary specialty office visits, faxing referral/authorization forms to PCPs and insurance companies in a timely fashion. The coordinator will review and notify front office staff of outstanding patient balances, maintain satisfactory productivity rates, and ensure the timeliness of claims reimbursement while meeting work queue goals. They will also respond to in-house provider and support staff questions regarding referrals, care coordination, or follow-up status, and identify and communicate trends or potential issues to the management team. Additionally, the role involves indexing referrals to patient accounts for existing patients and creating new patient accounts for non-established patients to index referrals. The job holder must demonstrate current competencies for the job position.

Requirements

• Must have Healthcare experience with Managed Care Insurance, requesting Referrals, Authorizations for Insurance and 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 in and prior auth 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

• 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

What This Job Offers

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