Healthcare Outcomes Performance
Referral and Authorization Coordinator
Healthcare Outcomes Performance, Phoenix, Arizona, United States, 85223
ESSENTIAL FUNCTIONS
Verifies and updates patient registration, such as demographic information and insurance eligibility including coordination of benefits information in the practice management system. Updates and confirms as necessary to allow processing of claims to insurance plans.
Obtains benefit verification and necessary authorization (referrals, precertification) prior to the 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.
Researches all information needed to complete 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 75-100 referrals daily. For primary specialty office visits, fax referral/authorization form to PCPs and insurance companies in a timely fashion.
Maintains satisfactory productivity rates and ensures the timeliness of document processing 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 management team.
Index referrals to patient accounts for existing patients.
Create new patient accounts for non-established patients to index referrals.
Call patients to schedule appointments based off referral/authorization received through tasks such as Outbound Lists and Campaigns.
Confirm online appointment booking was done correctly and make any necessary changes
Other duties as assigned.
The job holder must demonstrate current competencies for job position.
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 Athenahealth and Clearwave a plus.
REQUIREMENTS
Must have healthcare experience with Managed Care insurances, requesting Referrals, Authorizations for insurances and verifying insurance benefits.
In-depth knowledge on 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.
Skilled in using computer programs and applications.
Skilled in establishing good working relationships with both internal and external customers.
ABILITIES
Ability to multitask in a fast-paced environment. Must be detailed oriented with strong organizational skills.
Ability to understand patient demographic information and determine insurance eligibility.
ENVIRONMENTAL WORKING CONDITIONS
Normal office environment.
PHYSICAL/MENTAL DEMANDS
Requires sitting and standing associated with a normal office environment.
Some bending and stretching required.
Manual dexterity using a calculator and computer keyboard
ORGANIZATIONAL REQUIREMENTS
HOPCo Mission, Vision and Values must be read and signed.
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.
Equal Opportunity Employer. This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
#J-18808-Ljbffr
Verifies and updates patient registration, such as demographic information and insurance eligibility including coordination of benefits information in the practice management system. Updates and confirms as necessary to allow processing of claims to insurance plans.
Obtains benefit verification and necessary authorization (referrals, precertification) prior to the 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.
Researches all information needed to complete 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 75-100 referrals daily. For primary specialty office visits, fax referral/authorization form to PCPs and insurance companies in a timely fashion.
Maintains satisfactory productivity rates and ensures the timeliness of document processing 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 management team.
Index referrals to patient accounts for existing patients.
Create new patient accounts for non-established patients to index referrals.
Call patients to schedule appointments based off referral/authorization received through tasks such as Outbound Lists and Campaigns.
Confirm online appointment booking was done correctly and make any necessary changes
Other duties as assigned.
The job holder must demonstrate current competencies for job position.
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 Athenahealth and Clearwave a plus.
REQUIREMENTS
Must have healthcare experience with Managed Care insurances, requesting Referrals, Authorizations for insurances and verifying insurance benefits.
In-depth knowledge on 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.
Skilled in using computer programs and applications.
Skilled in establishing good working relationships with both internal and external customers.
ABILITIES
Ability to multitask in a fast-paced environment. Must be detailed oriented with strong organizational skills.
Ability to understand patient demographic information and determine insurance eligibility.
ENVIRONMENTAL WORKING CONDITIONS
Normal office environment.
PHYSICAL/MENTAL DEMANDS
Requires sitting and standing associated with a normal office environment.
Some bending and stretching required.
Manual dexterity using a calculator and computer keyboard
ORGANIZATIONAL REQUIREMENTS
HOPCo Mission, Vision and Values must be read and signed.
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.
Equal Opportunity Employer. This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
#J-18808-Ljbffr