Referral Coordinator

ESSENTIAL FUNCTIONS • Verifies and updates patient registration information in the practice management system. • Obtains benefit verification and necessary authorizations (referrals, precertification) before 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. • Creates appropriate referrals to attach to pending visits. • 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. • 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. • 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.

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. Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws.

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