Referrals and Precertification Coordinator

Retina Consultants of Houston • Houston, TX

6d • Onsite

About The Position

Retina Consultants of Texas (RCTX) is seeking a Referral and Precertification Coordinator who will be responsible for obtaining benefit verifications, referrals, and authorizations for ambulatory visits, procedures, and injections. Retina Consultants of Texas is the largest and most respected retina-only ophthalmology practice in the United States, with 26 world-renowned physicians. The practice serves two major metropolitan markets and emphasizes a culture of 'Retina Warriors' with core values of Hard Work, Authentic Care, and Innovation. RCTX invests in state-of-the-art diagnostic equipment and provides a high-quality patient experience through its dedicated staff and physicians. The position offers competitive benefits for full-time eligible employees after a 60-day introductory period.

Requirements

• High School Diploma or GED required.
• 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.

Nice To Haves

• Bachelor’s Degree preferred.

Responsibilities

• Obtains benefit verification and necessary authorizations (referrals, precertification) prior to patient arrival for all ambulatory visits, procedures, injections and radiology services.
• 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 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.
• Performs other related duties as assigned.

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) from starting date of hire.
• 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
• 8 paid holidays + 1 floating holiday annually.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED