Referral and Authorization Coordinator

2 weeks ago

Phoenix, AZ, United States HOPCO Full time
ESSENTIAL FUNCTIONS
  • 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.
  • 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 the management team.
  • Index referrals to patients account for existing patients.
  • Create new patient accounts for non-established patients to index referrals.
  • Assist in training new team members as directed
  • Maintain current knowledge of payer authorization requirements across commercial, Medicare, Medicaid, and managed care plans.
  • Communicate with physician offices, patients, and payers to ensure all necessary authorizations are in place prior to the date of service.
  • Document all payer communications, authorization status, and outcomes in the electronic medical record (EMR) or patient account system.
  • Collaborate 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.
  • 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.
REQUIREMENTS
  • Must have 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
  • Working 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 Window based programs.
SKILLS
  • Skilled in defusing difficult situations and able to be 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.
  • Must be detailed 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 are required.
  • Manual dexterity using a calculator and computer keyboard.
ORGANIZATIONAL REQUIREMENTS
  • HOPCo Mission, Vision, and Values must be acknowledged and adhered to

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

  • Occupational Health Services Coordinator

    1 week ago

    Phoenix, AZ, United States Medicine for Business and Industry Full time

    Summary The Occupational Health Services Coordinator plays a pivotal role in supporting the delivery of high-quality occupational health services across multiple states. This position handles coordinating medical referrals, managing authorizations, scheduling diagnostic services, and ensuring compliance with state-specific workers' compensation regulations...

  • Occupational Health Services Coordinator

    7 days ago

    Phoenix, AZ, United States Medicine for Business and Industry Full time

    Summary The Occupational Health Services Coordinator plays a pivotal role in supporting the delivery of high-quality occupational health services across multiple states. This position handles coordinating medical referrals, managing authorizations, scheduling diagnostic services, and ensuring compliance with state-specific workers' compensation regulations...

  • Occupational Health Services Coordinator

    2 weeks ago

    Phoenix, AZ, United States Medicine for Business and Industry Full time

    Summary The Occupational Health Services Coordinator plays a pivotal role in supporting the delivery of high-quality occupational health services across multiple states. This position handles coordinating medical referrals, managing authorizations, scheduling diagnostic services, and ensuring compliance with state-specific workers' compensation regulations...

  • Procedure Authorization Specialist

    2 days ago

    Phoenix, AZ, United States HOPCO Full time

    ESSENTIAL FUNCTIONS Monitors the authorizations of upcoming surgical cases on the physician's calendars ensuring authorizations for surgeries are obtained in a timely and accurate manner. Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms necessary information to allow processing of...

  • Insurance Authorization Refer

    1 week ago

    Phoenix, AZ, United States CommonSpirit Health Full time

    Job Summary and Responsibilities The Insurance Authorization/Referral Specialist will perform the following: Obtains authorizations and referrals for hospital procedures and multi-specialties services in a timely manner. Accurately enters patient and authorization information into both the hospital and clinic system. Provides training to office staff...

  • Authorization Specialist

    3 days ago

    Phoenix, AZ, United States American Vision Partners Full time

    Company Intro At American Vision Partners (AVP), we partner with the most respected ophthalmology practices in the country and integrate best-in-class management systems, operational infrastructure, and advanced technology to provide the highest quality patient care possible. Our practices include Barnet Dulaney Perkins Eye Center, Southwestern Eye Center,...

  • Medicaid Referrals

    1 day ago

    Phoenix, AZ, United States Morgan Stephens Full time

    Medicaid Referrals / Outreach Manager - Home Care (Remote) Location: Phoenix, AZ 85004 Employment Type: Full-Time Work Model: Remote (must reside in Arizona; occasional local field meetings required) About the Role A rapidly growing national home care organization has recently opened a new Arizona market and is seeking a Medicaid Referrals / Outreach Manager...

  • Medicaid Referrals

    2 weeks ago

    Phoenix, AZ, United States Morgan Stephens Full time

    Medicaid Referrals / Outreach Manager - Home Care (Remote) Location: Phoenix, AZ 85004 Employment Type: Full-Time Work Model: Remote (must reside in Arizona; occasional local field meetings required) About the Role A rapidly growing national home care organization has recently opened a new Arizona market and is seeking a Medicaid Referrals / Outreach Manager...

  • Medicaid Referrals

    1 week ago

    Phoenix, AZ, United States Morgan Stephens Full time

    Medicaid Referrals / Outreach Manager - Home Care (Remote) Location: Phoenix, AZ 85004 Employment Type: Full-Time Work Model: Remote (must reside in Arizona; occasional local field meetings required) About the Role A rapidly growing national home care organization has recently opened a new Arizona market and is seeking a Medicaid Referrals / Outreach Manager...

  • Foreclosure Referrals Processor

    5 days ago

    Phoenix, AZ, United States Workway Full time

    Workway BancForce is a premier national staffing firm that places qualified job-seeking candidates across the nation in direct hire, temp-to-hire, and temporary positions across a variety of specialized fields. We are looking for aForeclosure Referrals Processor for our industry leading specialty law firm client, in their Phoenix office. The firm...