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Referral and Authorization Coordinator I- Full-time Remote

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<ul> <li>Verifies and updates patient registration information in the practice management system.</li> <li>Obtains benefit verification and necessary authorizations (referrals, precertification) before patient arrival for all ambulatory visits, procedures, injections, and radiology services.</li> <li>Uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility.</li> <li>Creates appropriate referrals to attach to pending visits.</li> <li>Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.</li> <li>Completes chart prepping tasks daily to ensure a smooth check-in process for the patient and clinic.</li> <li>Researches all information needed to complete the registration process including obtaining information from providers, ancillary services staff, and patients.</li> <li>Fax referral form to providers that do not require any records to be sent. Be able to process 75-80 referrals daily. For primary specialty office visits, fax referral/authorization forms to PCPs and insurance companies in a timely fashion.</li> <li>Reviews and notifies front office staff of outstanding patient balances.</li> <li>Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue goals.</li> <li>Respond to In-house provider and support staff questions, requests, and concerns regarding the status of patient referrals, care coordination, or follow-up status.</li> <li>Identifies and communicates trends and/or potential issues to the management team.</li> <li>Index referrals to patients account for existing patients.</li> <li>Create new patient accounts for non-established patients to index referrals.</li> <li>Assist in training new team members as directed</li> <li>Maintain current knowledge of payer authorization requirements across commercial, Medicare, Medicaid, and managed care plans.</li> <li>Communicate with physician offices, patients, and payers to ensure all necessary authorizations are in place prior to the date of service.</li> <li>Document all payer communications, authorization status, and outcomes in the electronic medical record (EMR) or patient account system.</li> <li>Collaborate with clinical, registration, and billing staff to avoid service delays and ensure clean claim submission.</li> </ul> <p><strong>EDUCATION</strong></p> <ul> <li>High school diploma/GED or equivalent working knowledge preferred.</li> </ul> <p><strong>EXPERIENCE</strong></p> <ul> <li>Minimum two to three years of experience in a healthcare environment in a referral, front desk, or billing role.</li> <li>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.</li> <li>Working knowledge of Centricity Practice Management and Centricity EMR a plus.</li> </ul> <p><strong>REQUIREMENTS</strong></p> <ul> <li>Must have healthcare experience with managed care insurances, requesting referrals, authorizations for insurances, and verifying insurance benefits.</li> <li>In-depth knowledge of insurance plan requirements for Medicaid and commercial plans.</li> </ul> <p><strong>KNOWLEDGE </strong></p> <ul> <li>Working knowledge of eligibility verification and prior authorizations for payment from various HMOs, PPOs, commercial payers, and other funding sources.</li> <li>Knowledge of government provisions and billing guidelines including Coordination of Benefits.</li> <li>Advanced computer knowledge, including Window based programs.</li> </ul> <p><strong>SKILLS</strong></p> <ul> <li>Skilled in defusing difficult situations and able to be consistently pleasant and helpful.</li> <li>Skill in using computer programs and applications.</li> <li>Skill in establishing good working relationships with both internal and external customers.</li> </ul> <p><strong>ABILITIES</strong></p> <ul> <li>Ability to multi-task in a fast-paced environment.</li> <li>Must be detailed oriented with strong organizational skills.</li> <li>Ability to understand patient demographic information and determine insurance eligibility.</li> <li>Ability to type a minimum of 45 wpm.</li> </ul> <p><strong>ENVIRONMENTAL WORKING CONDITIONS</strong></p> <ul> <li>Normal office environment</li> </ul> <p><strong>PHYSICAL/MENTAL DEMANDS</strong></p> <ul> <li>Requires sitting and standing associated with a normal office environment.</li> <li>Some bending and stretching are required.</li> <li>Manual dexterity using a calculator and computer keyboard.</li> </ul>

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...