Referrals and Precertification Coordinator

Retina Consultants of Texas•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 supports patient care and coordination across RCTX, a retina-only ophthalmology practice with 26 physicians and 25 locations serving two major metropolitan markets and their surrounding areas. RCTX emphasizes Hard Work, Authentic Care, and Innovation.

Requirements

High school diploma or GED required.
Minimum of two to three years of experience in a healthcare environment in a referral, front desk, or billing role.

Nice To Haves

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

Responsibilities

Obtain benefit verification and necessary authorizations, including referrals and precertification, before patient arrival for ambulatory visits, procedures, injections, and radiology services.
Use Web IVR systems such as Availity, Optum, and other approved platforms to process authorizations and referrals.
Obtain recertification for cases requiring extended treatment or coverage beyond the original approval expiration.
Create appropriate referrals to attach to pending visits.
Fax referral forms to providers that do not require records to be sent, processing 75–80 referrals daily.
Respond to in-house provider and support staff questions, requests, and concerns about patient referrals, care coordination, and authorization status.
Participate in call center activities and triage and respond to incoming calls from patients, insurance companies, and physicians; may 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 techniques, 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.

Benefits

Medical, dental, and vision insurance for eligible full-time employees after a 60-day introductory period.
Short-term disability, voluntary life insurance, accident insurance, critical illness insurance, hospital indemnity, and pet insurance.
Pre-tax HSA contributions and 401(k) retirement savings contributions with Roth and Traditional options from the starting date of hire.
Employer-paid long-term disability and a $25,000 basic life insurance policy.
3% 401(k) safe harbor contribution and employer HSA contributions.
Annual performance merit increases.
Certification opportunities.
Rewards and recognition platform.
WellHub Starter Plan gym membership.
Paid time off.
Eight paid holidays and one floating holiday annually.