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Insurance Authorization Coordinator

2 months ago


San Antonio, Texas, United States Christus Health Full time

Position Overview:

The role of the Referral Coordination Specialist involves overseeing the complete referral workflow. This includes acquiring orders from healthcare providers, securing insurance approvals, scheduling patient appointments with participating physicians, and informing patients about their appointments. Additionally, the specialist will handle renewal authorizations with both the physician's office and the insurance payor.

Key Responsibilities:

  • Investigate and resolve issues related to referral claims or payment requests.
  • Ensure that physician coding and diagnoses are accurate to facilitate appropriate referrals and insurance coverage.
  • Maintain a comprehensive understanding of various insurance plans and patient coverages to guarantee correct billing.
  • Educate nursing staff and physicians on updates and changes within insurance plans affecting referrals and authorizations.
  • Stay current with all relevant CPT and ICD-9 coding to ensure proper referral processing.
  • Utilize clinical knowledge to effectively communicate with insurance companies regarding referrals.

About CHRISTUS Health:

CHRISTUS Children's Hospital, a pioneer in pediatric care since 1959, serves a diverse population of children from various regions. The facility is recognized for its specialized services tailored to meet the unique healthcare needs of children, including but not limited to Pediatric and Neonatal Intensive Care, Emergency Services, and a dedicated Cancer and Blood Disorders Center.

Qualifications:

  • A High School Diploma or equivalent is mandatory.
  • A minimum of 3 years of experience in an administrative role within a healthcare environment is required.
  • In-depth knowledge of managed care benefit plans, with at least 1 year of experience in a referral-centric clinic or physician's office.
  • Certification as a medical assistant from an accredited institution is preferred.

Employment Type:

This is a Full-Time position.

Equal Employment Opportunity:

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