Healthcare Outcomes Performance Co. (HOPCo)
Referral and Authorization Coordinator
Healthcare Outcomes Performance Co. (HOPCo), Folsom, Pennsylvania, United States
2 days ago – Be among the first 25 applicants
Premier Orthopaedics
is looking for a
Referral and Authorization Coordinator
to work at our Folsom, PA office.
About Us Premier is a leading orthopedic practice committed to diagnosing and treating a wide range of orthopedic injuries and conditions. We operate in over 50 locations and have more than 55 physicians dedicated to providing exceptional care across the Greater Philadelphia area. With a team of nearly 1,000 employees, we thrive in a supportive environment that prioritizes collaboration and patient satisfaction.
What We Offer
Comprehensive Benefits: Enjoy medical, vision, and dental plans, 100% employer‑paid life insurance, and a generous 401(k) match.
Work‑Life Balance: Generous paid sick and vacation time, plus 7 paid holidays each year.
Flexible Work Hours: Embrace a morning or evening work schedule that supports your lifestyle.
Career Growth: Excellent opportunities for professional development and advancement.
Employee Rewards: Participate in our employee referral reward program and celebrate your contributions.
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 the 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.
Faxes referral form to providers that do not require any records to be sent. Processes 75–80 referrals daily. For primary specialty office visits, faxes 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.
Responds 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.
Indexes referrals to patients’ accounts for existing patients.
Creates 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 Allscripts Practice Management and Allscripts EMR is 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 Windows 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 detail‑oriented with strong organizational skills.
Ability to understand patient demographic information and determine insurance eligibility.
Ability to type a minimum of 45 wpm.
Seniority Level
Entry level
Employment Type
Full‑time
Job Function
Health Care Provider
Hospitals and Health Care
#J-18808-Ljbffr
Premier Orthopaedics
is looking for a
Referral and Authorization Coordinator
to work at our Folsom, PA office.
About Us Premier is a leading orthopedic practice committed to diagnosing and treating a wide range of orthopedic injuries and conditions. We operate in over 50 locations and have more than 55 physicians dedicated to providing exceptional care across the Greater Philadelphia area. With a team of nearly 1,000 employees, we thrive in a supportive environment that prioritizes collaboration and patient satisfaction.
What We Offer
Comprehensive Benefits: Enjoy medical, vision, and dental plans, 100% employer‑paid life insurance, and a generous 401(k) match.
Work‑Life Balance: Generous paid sick and vacation time, plus 7 paid holidays each year.
Flexible Work Hours: Embrace a morning or evening work schedule that supports your lifestyle.
Career Growth: Excellent opportunities for professional development and advancement.
Employee Rewards: Participate in our employee referral reward program and celebrate your contributions.
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 the 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.
Faxes referral form to providers that do not require any records to be sent. Processes 75–80 referrals daily. For primary specialty office visits, faxes 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.
Responds 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.
Indexes referrals to patients’ accounts for existing patients.
Creates 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 Allscripts Practice Management and Allscripts EMR is 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 Windows 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 detail‑oriented with strong organizational skills.
Ability to understand patient demographic information and determine insurance eligibility.
Ability to type a minimum of 45 wpm.
Seniority Level
Entry level
Employment Type
Full‑time
Job Function
Health Care Provider
Hospitals and Health Care
#J-18808-Ljbffr