Referral and Eligibility Coordinator

Mid-Atlantic Nephrology Associates PA•Baltimore, MD

12h

About The Position

Summary : Perform all activities associated with gathering, verifying, applying and maintaining accurate patient demographic and insurance information, for all service lines (office new, dialysis, hospital), at a satisfactory level of quality and productivity. Responsible for ensuring appropriate and effective authorizations and referrals are on file for all physician office charges. Essential Duties and Responsibilities include the following. Other duties may be assigned . 1) Collects and documents critical information accurately and completely. Updates information per policy. a. The R&E Coordinator is responsible for the quality, accuracy and completeness of demographic information b. Performs insurance verifications as indicated by company policy by utilizing online websites, sources, payer sites, and other tools c. Understands the impact of how this role affects the performance of the revenue cycle as well as the client experience d. Ensures that the verification of eligibility, the coordination of benefits, the procurement of referrals and authorizations are performed proactively and prior to the patient visit and/or claim generation e. Becomes the subject matter expert as it relates to carrier requirements and accurate demographic entries f. Accurately and completely enters information into the Practice Management and Verification Systems (eligibility field) as designated by policy g. Demonstrates knowledge of importance of referring physician and other critical information and is diligent in gathering information h. Utilizes various information sources for patient demographic and insurance information such as but not limited to referring physician office, hospital’s patient accounting department and patient i. Processes insurance discovery when patient reports as self-pay j. Utilizes all tools to research for payer prior to reporting balance to collection agency k. Work assigned EHR tasks, e-mails and Work Queues. 2) Interacts with the patient and others in a professional manner. a. Demonstrates confidence and speaks appropriately with patients in gathering information b. Explains COB guidelines to patients as needed c. Works collaboratively with all revenue cycle departments to provide the optimal client and patience experience 3) Provides support to others. a. Can handle multiple tasks at once b. Attend and actively participate in individual, group and department meetings c. Provide back-up as required to ensure all intake deadlines are met d. Other duties as assigned Supervisory Responsibilities: This job has no supervisory responsibilities. Competencies: To perform the job successfully, an individual should demonstrate the following competencies: Adaptability Initiative Judgment Verbal and Written Communication Professionalism Teamwork approach Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Requirements

High school diploma or general education degree (GED); or two to four years related experience and/or training; or equivalent combination of education and experience.
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
Ability to deal with problems involving several concrete variables in standardized situations.
Knowledge of Word Processing software
Knowledge of Spreadsheets
Knowledge of E-Mail
Knowledge of Allscripts and Touchworks EMR
Knowledge of Internet Software
Prospective employees must pass a criminal background check.

Responsibilities

Collects and documents critical information accurately and completely.
Updates information per policy.
Performs insurance verifications as indicated by company policy by utilizing online websites, sources, payer sites, and other tools
Ensures that the verification of eligibility, the coordination of benefits, the procurement of referrals and authorizations are performed proactively and prior to the patient visit and/or claim generation
Accurately and completely enters information into the Practice Management and Verification Systems (eligibility field) as designated by policy
Utilizes various information sources for patient demographic and insurance information such as but not limited to referring physician office, hospital’s patient accounting department and patient
Processes insurance discovery when patient reports as self-pay
Utilizes all tools to research for payer prior to reporting balance to collection agency
Work assigned EHR tasks, e-mails and Work Queues.
Interacts with the patient and others in a professional manner.
Works collaboratively with all revenue cycle departments to provide the optimal client and patience experience
Can handle multiple tasks at once
Attend and actively participate in individual, group and department meetings
Provide back-up as required to ensure all intake deadlines are met
Other duties as assigned