Referral and Authorization Coordinator - PRN

Verifies and updates patient registration information in the practice management system.

• Obtains benefit verification and necessary authorizations (referrals, precertification) prior to 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.
• 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 smooth check‑in process for the patient and clinic.
• 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 75‑80 referrals on a daily basis.

For primary specialty office visits, fax referral/authorization form 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.
• 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.
• The job holder must demonstrate current competencies for the job position.

• High school diploma/GED or equivalent working knowledge preferred.

• 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 Centricity Practice Management and Centricity EMR a plus.