Referral and Authorization Coordinator

Premier Orthopedics and Sports Medicine is looking for aReferral and Authorization Coordinatorto work at our Philadelphia Hand to Shoulder corporate office in Folsom PA.

AtPremier Orthopaedics we are dedicated to taking care of you so you can take care of business! Our robust benefits package includes the following:

• Competitive Health & Welfare Benefits
• Monthly $43 stipend to use toward ancillary benefits
• HSA with qualifying HDHP plans with company match
• 401k plan after 6 months of service with company match (Parttime employees included)
• Employee Assistance Program that is available 24/7 to provide support
• Employee Appreciation Days
• Employee Wellness Events

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 webbased verification systems and reviews realtime 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 a smooth checkin 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.
• Fax referral form to providers that do not require any records to be sent. Be able to process 7580 referrals daily. For primary specialty office visits fax referral/authorization forms 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 Inhouse provider and support staff questions requests and concerns regarding the status of patient referrals care coordination or followup 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 nonestablished patients to index referrals.

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 Allscripts Practice Management and Allscripts EMR is a plus.

REQUIREMENTS

• Must have healthcare experience with managed care insurances requesting referrals authorizations for insurances and verifying insurance benefits.
• Indepth 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 multitask in a fastpaced 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.

Required Experience:

IC