Referrals and Precertification Coordinator

Referrals and Precertification Coordinator Retina Houston MSO LLC Houston, TX Job Details 20 hours ago Qualifications High school diploma or

GED Full Job Description Job Summary :

The Referral and Precertification Coordinator will be responsible for obtaining benefit verifications, referrals, and authorizations for ambulatory visits, procedures, and injections. Uses web-based systems to process requests and ensures approvals are secured before patient appointments. Communicates with providers, patients, and insurers to support care coordination. Maintains compliance and assists with call center activities as needed. Obtains benefit verification and necessary authorizations (referrals, precertification) prior to patient arrival for all ambulatory visits, procedures, injections and radiology services. Uses Web IVR to generate authorizations and referrals (Availity, Optum, and any other approved web IVR for authorization processing). Obtain recertification for cases requiring extended treatment/coverage beyond the expiration of original approval. Creates appropriate referrals to attach to pending visits. Fax referral form to providers that do not require any records to be sent. Be able to process 75-80 referrals on a daily basis. Respond to In-house provider and support staff questions, requests and concerns regarding the status of patient referrals, care coordination and authorization status. Participate in Call Center Activities, triage and respond to incoming calls from patients, insurance companies, and physicians. May serve as single point of contact for an assigned group of prescribers. Educate patients, prescribers, and others regarding program requirements, and facilitate referrals. Maintain good housekeeping techniques, adhering to quality and production standards and comply with all applicable company, state, and federal safety and environmental programs and procedures. Identifies and communicates trends and/or potential issues to management team. Performs other related duties as assigned. High School Diploma or GED required. Bachelor's Degree preferred. Minimum two to three years of experience in a healthcare environment in a referral, front desk or billing role. Healthcare experience with Managed Care Insurances, requesting Referrals, Prior Authorizations' for Insurances and verifying Insurance benefits preferred In-depth knowledge on insurance plan requirements for Medicaid and commercial plans preferred.