Referral and Authorization Coordinator I- Full-time Remote

<ul> <li>Verifies and updates patient registration information in the practice management system.</li> <li>Obtains benefit verification and necessary authorizations (referrals, precertification) before patient arrival for all ambulatory visits, procedures, injections, and radiology services.</li> <li>Uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility.</li> <li>Creates appropriate referrals to attach to pending visits.</li> <li>Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.</li> <li>Completes chart prepping tasks daily to ensure a smooth check-in process for the patient and clinic.</li> <li>Researches all information needed to complete the registration process including obtaining information from providers, ancillary services staff, and patients.</li> <li>Fax referral form to providers that do not require any records to be sent. Be able to process 75-80 referrals daily. For primary specialty office visits, fax referral/authorization forms to PCPs and insurance companies in a timely fashion.</li> <li>Reviews and notifies front office staff of outstanding patient balances.</li> <li>Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue goals.</li> <li>Respond to In-house provider and support staff questions, requests, and concerns regarding the status of patient referrals, care coordination, or follow-up status.</li> <li>Identifies and communicates trends and/or potential issues to the management team.</li> <li>Index referrals to patients account for existing patients.</li> <li>Create new patient accounts for non-established patients to index referrals.</li> <li>Assist in training new team members as directed</li> <li>Maintain current knowledge of payer authorization requirements across commercial, Medicare, Medicaid, and managed care plans.</li> <li>Communicate with physician offices, patients, and payers to ensure all necessary authorizations are in place prior to the date of service.</li> <li>Document all payer communications, authorization status, and outcomes in the electronic medical record (EMR) or patient account system.</li> <li>Collaborate with clinical, registration, and billing staff to avoid service delays and ensure clean claim submission.</li> </ul> <p><strong>EDUCATION</strong></p> <ul> <li>High school diploma/GED or equivalent working knowledge preferred.</li> </ul> <p><strong>EXPERIENCE</strong></p> <ul> <li>Minimum two to three years of experience in a healthcare environment in a referral, front desk, or billing role.</li> <li>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.</li> <li>Working knowledge of Centricity Practice Management and Centricity EMR a plus.</li> </ul> <p><strong>REQUIREMENTS</strong></p> <ul> <li>Must have healthcare experience with managed care insurances, requesting referrals, authorizations for insurances, and verifying insurance benefits.</li> <li>In-depth knowledge of insurance plan requirements for Medicaid and commercial plans.</li> </ul> <p><strong>KNOWLEDGE </strong></p> <ul> <li>Working knowledge of eligibility verification and prior authorizations for payment from various HMOs, PPOs, commercial payers, and other funding sources.</li> <li>Knowledge of government provisions and billing guidelines including Coordination of Benefits.</li> <li>Advanced computer knowledge, including Window based programs.</li> </ul> <p><strong>SKILLS</strong></p> <ul> <li>Skilled in defusing difficult situations and able to be consistently pleasant and helpful.</li> <li>Skill in using computer programs and applications.</li> <li>Skill in establishing good working relationships with both internal and external customers.</li> </ul> <p><strong>ABILITIES</strong></p> <ul> <li>Ability to multi-task in a fast-paced environment.</li> <li>Must be detailed oriented with strong organizational skills.</li> <li>Ability to understand patient demographic information and determine insurance eligibility.</li> <li>Ability to type a minimum of 45 wpm.</li> </ul> <p><strong>ENVIRONMENTAL WORKING CONDITIONS</strong></p> <ul> <li>Normal office environment</li> </ul> <p><strong>PHYSICAL/MENTAL DEMANDS</strong></p> <ul> <li>Requires sitting and standing associated with a normal office environment.</li> <li>Some bending and stretching are required.</li> <li>Manual dexterity using a calculator and computer keyboard.</li> </ul>