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Referral and Authorization Coordinator
Referral and Authorization CoordinatorThe Center for Orthopedic and Research E • Phoenix, AZ, US
Referral and Authorization Coordinator

Referral and Authorization Coordinator

The Center for Orthopedic and Research E • Phoenix, AZ, US
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Job Description

Job Description

ESSENTIAL FUNCTIONS

  • Verifies and updates patient registration information in the practice management system.
  • Obtains benefit verification and necessary authorizations (referrals, precertification) after patient arrival for all ambulatory visits, procedures, injections, and radiology services.
  • Uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility.
  • Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
  • Completes chart prepping tasks daily to ensure a smooth check-in process for the patient and clinic.
  • Researches all information needed to complete the registration process including obtaining information from providers, ancillary services staff, and patients.
  • Reviews and notifies front office staff of outstanding patient balances.
  • Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue goals.
  • Respond to In-house provider and support staff questions, requests, and concerns regarding the status of patient referrals, care coordination, or follow-up status.
  • Identifies and communicates trends and / or potential issues to the management team.
  • Index referrals to patients account for existing patients.
  • Create new patient accounts for non-established patients to index referrals.
  • Assist in training new team members as directed
  • Maintain current knowledge of payer authorization requirements across commercial, Medicare, Medicaid, and managed care plans.
  • Communicate with physician offices, patients, and payers to ensure all necessary authorizations are in place prior to the date of service.
  • Document all payer communications, authorization status, and outcomes in the electronic medical record (EMR) or patient account system.
  • Collaborate with clinical, registration, and billing staff to avoid service delays and ensure clean claim submission.

EDUCATION

  • High school diploma / GED or equivalent working knowledge preferred.

    • EXPERIENCE

  • Minimum two to three years of experience in a healthcare environment in a referral, front desk, or billing role.
  • 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.
  • Working knowledge of Centricity Practice Management and Centricity EMR a plus.

    • REQUIREMENTS

  • Must have healthcare experience with managed care insurances, requesting referrals, authorizations for insurances, and verifying insurance benefits.
  • In-depth knowledge of insurance plan requirements for Medicaid and commercial plans.

    • KNOWLEDGE

  • Working knowledge of eligibility verification and prior authorizations for payment from various HMOs, PPOs, commercial payers, and other funding sources.
  • Knowledge of government provisions and billing guidelines including Coordination of Benefits.
  • Advanced computer knowledge, including Window based programs.

    • SKILLS

  • Skilled in defusing difficult situations and able to be consistently pleasant and helpful.
  • Skill in using computer programs and applications.
  • Skill in establishing good working relationships with both internal and external customers.

    • ABILITIES

  • Ability to multi-task in a fast-paced environment.
  • Must be detailed oriented with strong organizational skills.
  • Ability to understand patient demographic information and determine insurance eligibility.
  • Ability to type a minimum of 45 wpm.

    • ENVIRONMENTAL WORKING CONDITIONS

  • Normal office environment

    • PHYSICAL / MENTAL DEMANDS

  • Requires sitting and standing associated with a normal office environment.
  • Some bending and stretching are required.
  • Manual dexterity using a calculator and computer keyboard.

    • ORGANIZATIONAL REQUIREMENTS

  • HOPCo Mission, Vision, and Values must be acknowledged and adhered to

    • This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve.

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