Referrals and Precertification Coordinator

ECG Management Consultants•Houston, TX

9d•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 core values of Hard Work, Authentic Care, and Innovation. RCTX invests in state-of-the-art diagnostic equipment and provides a supportive culture for its team.

Requirements

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.

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.