Referrals and Precertification Coordinator

Retina Consultants of Texas • Houston, TX

73d

About The Position

Retina Consultants of Texas (RCTX) is seeking Insurance Verification Coordinator to join our innovative team with the mission of Fighting Blindness For The World To See. This position will be responsible for handling benefit verifications, referrals, and prior authorizations for ambulatory services. It involves supporting providers, patients, and insurance companies by coordinating care and addressing inquiries. The position uses web-based systems to process authorizations and ensures compliance with all applicable guidelines. It also includes participating in call center activities and performing administrative tasks to support patient access and care coordination. Candidates must be able to meet the needs of the patients and providers, and support the Eligibility and Benefits Department hours of Monday through Friday, 8:00am - 5:00pm. Schedules are provided weekly and are based on the provider's clinic, patient and surgery schedules. Retina Consultants of Texas is the largest and most respected retina-only ophthalmology practice in the United States. Our group consists of 26 world renowned physicians leading the world in retinal care. While serving two major metropolitan markets (and their extensions) our combined culture allows us to best serve our patients, referral sources and our own team of physicians. RCTX also invests heavily in diagnostic equipment, providing state-of-the-art retina imaging, laser and diagnostic capabilities to each patient. This, combined with the clinical expertise of our physicians, an outstanding and devoted staff, and 25 convenient locations to serve our patients. We worked hard to create our culture as Retina Warriors. We strongly emphasize our core values of Hard Work, Authentic Care and Innovation in everything we do. It is our belief that by investing in our people, our people will be empowered of their own accord to provide the highest quality patient experience.

Requirements

• High School diploma or GED. Bachelor's degree preferred.
• Minimum two to three years of experience in a healthcare environment in a referral, front desk or billing role.
• Healthcare experience with Managed Care Insurances, requesting Referrals, Prior Authorizations for Insurances and verifying Insurance benefits preferred.
• In-depth knowledge on insurance plan requirements for Medicaid and commercial plans preferred.
• 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.
• Excellent written and verbal communication skills, with demonstrated ability to communicate with others at all levels.
• Computer proficiency in MS Office applications, with EHR/PM experience a plus.
• Ability to manage multiple priorities in a fast paced environment and meet deadlines.

Responsibilities

• Obtains benefit verification and necessary authorizations (referrals, precertification) prior to patient arrival for all ambulatory visits, procedures, and injections.
• Uses Web IVR to generate authorizations and referrals (Availity, Optum, and any other approved web IVR for authorization processing).
• Obtain recertification for cases requiring extended treatment/coverage beyond the expiration of original approval.
• Creates appropriate referrals to attach to pending visits.
• Fax referral form to providers that do not require any records to be sent.
• Be able to process 75-80 precert/referrals on a daily basis.
• Respond to In-house provider and support staff questions, requests and concerns regarding the status of patient referrals, care coordination and authorization status.
• Participate in Call Center Activities, triage and respond to incoming calls from patients, insurance companies, and physicians. May serve as single point of contact for an assigned group of prescribers.
• Educate patients, prescribers, and others regarding program requirements, and facilitate referrals.
• Maintain good housekeeping techniques, adhering to quality and production standards and comply with all applicable company, state, and federal safety and environmental programs and procedures.
• Identifies and communicates trends and/or potential issues to management team.

Benefits

• Employee Paid Benefits such as Medical, Dental, and Vision, short-term disability, voluntary life insurance, accident, critical illness, hospital indemnity, pet insurance, HSA pre-taxed contributions, 401 (k) retirement savings contributions both Roth and Traditional options starting date of hire.
• Employer Paid Benefits such as long-term disability, $25,000 basic life insurance policy, 3% 401(k) safe harbor contribution, HSA employer contributions, annual performance merit increases, certification opportunities, rewards & recognition platform, WellHub Starter Plan Gym Membership, paid time off and (8) paid holidays + (1) floating holiday annually.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED
• Number of Employees: 101-250 employees