Referrals and Precertification Coordinator

Retina Consultants of Houston•Houston, TX

About The Position

Retina Consultants of Texas (RCTX) is seeking a Referrals and Precertification Coordinator to obtain benefit verifications, referrals, and authorizations for ambulatory visits, procedures, and injections. The role also supports radiology services and helps patients, prescribers, and staff navigate referral and authorization requirements. RCTX is a retina-only ophthalmology practice with 26 physicians and 25 locations. The organization emphasizes Hard Work, Authentic Care, and Innovation, and describes its culture as “Retina Warriors.”

Requirements

High school diploma or GED.
At least 2–3 years of experience in a healthcare environment in a referral, front desk, or billing role.

Nice To Haves

Bachelor’s degree.
Healthcare experience with managed care insurance, requesting referrals and insurance prior authorizations, and verifying insurance benefits.
In-depth knowledge of insurance plan requirements for Medicaid and commercial plans.

Responsibilities

Obtain benefit verifications and necessary authorizations, including referrals and precertifications, before patient arrival for ambulatory visits, procedures, injections, and radiology services.
Use Web IVR tools, including Availity, Optum, and other approved systems, to process authorizations and referrals.
Obtain recertification when treatment or coverage extends beyond the original approval’s expiration.
Create appropriate referrals for pending visits.
Fax referral forms to providers when no records need to be sent.
Process 75–80 referrals daily.
Respond to in-house provider and support staff questions, requests, and concerns about referral status, care coordination, and authorization status.
Participate in call center activities and triage and respond to calls from patients, insurance companies, and physicians.
Possibly serve as the single point of contact for an assigned group of prescribers.
Educate patients, prescribers, and others about program requirements and facilitate referrals.
Maintain good housekeeping practices, adhere to quality and production standards, and comply with applicable company, state, and federal safety and environmental programs and procedures.
Identify and communicate trends or potential issues to the management team.
Perform other related duties as assigned.