Referral and Authorization Coordinator

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.