Referrals and Precertification Coordinator

Responsibilities

• Obtains benefit verification and necessary authorizations (referrals, precertification) prior to patient arrival for all ambulatory visits, procedures, injections and radiology services.
• Uses Web IVR to generate authorizations and referrals (Availity, Optum, and any other approved web IVR for authorization processing).
• Obtain recertification for cases requiring extended treatment/coverage beyond the expiration of original approval.
• Creates appropriate referrals to attach to pending visits.
• Fax referral form to providers that do not require any records to be sent.
• Be able to process 75-80 referrals on a daily basis.
• Respond to In-house provider and support staff questions, requests and concerns regarding the status of patient referrals, care coordination and authorization status.
• Participate in Call Center Activities, triage and respond to incoming calls from patients, insurance companies, and physicians.
• May serve as single point of contact for an assigned group of prescribers.
• Educate patients, prescribers, and others regarding program requirements, and facilitate referrals.
• Maintain good housekeeping techniques, adhering to quality and production standards and comply with all applicable company, state, and federal safety and environmental programs and procedures.
• Identifies and communicates trends and/or potential issues to management team.
• Performs other related duties as assigned.

Qualifications

• A High School Diploma or GED required.
• A Bachelor’s Degree preferred.
• Minimum two to three years of experience in a healthcare environment in a referral, front desk or billing role.
• Healthcare experience with Managed Care Insurances, requesting Referrals, Prior Authorizations’ for Insurances and verifying Insurance benefits preferred.
• In-depth knowledge on insurance plan requirements for Medicaid and commercial plans preferred.