Referral/Billing/Reimbursement Coordinator

2 months ago


Charlottesville, Virginia, United States Commonwealth of Virginia Full time
Job Summary

We are seeking a highly skilled and detail-oriented individual to join our team as a Referral/Billing/Reimbursement Coordinator. This role will be responsible for providing billing and compliance support within the Division of Radiation Oncology, ensuring accurate and timely processing of referrals and charges.

Key Responsibilities
  • Manage referrals effectively and efficiently for Radiation Therapy Services, providing high-level customer service to referring physicians and patients.
  • Verify medical necessity for all radiation treatments based on patient diagnosis and medical insurance, applying and interpreting policies and procedures.
  • Complete referral forms accurately and enter necessary information into Epic.
  • Notify team members of pending referrals and inform patients of their responsibilities.
  • Coordinate with financial coordinators to ensure assistance is provided as needed.
  • Review insurance guidelines to determine if criteria are met for proceeding with planned treatment.
  • Consult with physicians to obtain additional information for medical necessity determination.
  • Maintain thorough knowledge of insurance company criteria and radiation-specific billing codes.
  • Communicate with physicians, department billing team, and preauthorization team to ensure accurate pre-certification/authorization information aligns with billing of services.
  • Advocate for patients by helping them navigate the system and accessing appropriate resources.
  • Develop tools to assess patient referral processes for efficiency and customer service.
  • Perform all other related tasks to facilitate the flow of patients through the process and enhance the quality of service to patients.
Requirements
  • High School Diploma
  • 2 years of relevant experience
  • Relevant coding certification, such as Radiation Oncology Certified Coder (ROCC), from an accredited organization (strongly preferred)
Physical Demands

This is a primarily sedentary job involving extensive use of desktop computers. Occasional travel may be required to attend meetings and programs.



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