Healthcare Outcomes Performance Co. (HOPCo)
Referral and Authorization Coordinator
Healthcare Outcomes Performance Co. (HOPCo), Phoenix, Arizona, United States, 85003
Referral Coordinator – Healthcare Outcomes Performance Co. (HOPCo)
Location: Phoenix, AZ
Pay: $1,500.00 - $3,800.00
Posted: 1 month ago
Responsibilities
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.
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.
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.
Assists in training new team members as directed.
Maintains current knowledge of payer authorization requirements across commercial, Medicare, Medicaid, and managed care plans.
Communicates with physician offices, patients, and payers to ensure all necessary authorizations are in place prior to the date of service.
Documents all payer communications, authorization status, and outcomes in the electronic medical record (EMR) or patient account system.
Collaborates 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.
Effective communication with physicians, patients, and the public; establishes good working relationships with both internal and external customers.
Working knowledge of Centricity Practice Management and Centricity EMR a plus.
Requirements
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
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 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.
Detail‑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 required.
Manual dexterity using a calculator and computer keyboard.
Organizational Requirements
HOPCo Mission, Vision, and Values must be acknowledged and adhered to.
Employment Information
Seniority level: Entry level
Employment type: Full‑time
Job function: Health Care Provider
Industries: Hospitals and Health Care
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Location: Phoenix, AZ
Pay: $1,500.00 - $3,800.00
Posted: 1 month ago
Responsibilities
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.
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.
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.
Assists in training new team members as directed.
Maintains current knowledge of payer authorization requirements across commercial, Medicare, Medicaid, and managed care plans.
Communicates with physician offices, patients, and payers to ensure all necessary authorizations are in place prior to the date of service.
Documents all payer communications, authorization status, and outcomes in the electronic medical record (EMR) or patient account system.
Collaborates 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.
Effective communication with physicians, patients, and the public; establishes good working relationships with both internal and external customers.
Working knowledge of Centricity Practice Management and Centricity EMR a plus.
Requirements
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
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 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.
Detail‑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 required.
Manual dexterity using a calculator and computer keyboard.
Organizational Requirements
HOPCo Mission, Vision, and Values must be acknowledged and adhered to.
Employment Information
Seniority level: Entry level
Employment type: Full‑time
Job function: Health Care Provider
Industries: Hospitals and Health Care
#J-18808-Ljbffr