Referral and Authorization Coordinator

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

EXPERIENCE

REQUIREMENTS

KNOWLEDGE

SKILLS

ABILITIES

ENVIRONMENTAL WORKING CONDITIONS

PHYSICAL / MENTAL DEMANDS

ORGANIZATIONAL REQUIREMENTS

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.