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Hybrid Referral Coordinator bei Ohio County Healthcare

Ohio County Healthcare · Hartford, Vereinigte Staaten Von Amerika · Hybrid

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Job Details

Job Location:    OCH MOB/Quick Care - Hartford, KY
Position Type:    Full Time
Salary Range:    Undisclosed
Job Shift:    Weekday Days

Description

Description 

The Referral Coordinator is responsible for verifying patient’s insurance eligibility to determine coverage and benefits for services provided, obtaining prior authorizations/referrals for all procedural orders by successfully completing the authorization process with all commercial payers and provide insurance policy education to patients.   

Knowledge and Skills: 

  • Excellent working knowledge of insurance carriers’ payment regulations, copays, coinsurance and deductibles, in-network and out-of -network providers. 

  • Knowledge of insurance guidelines; including Medicare, HMO, PPO, & KY Medicaid 

  • Experience in health insurance verification preferred 

  • High attention to detail and accuracy 

  • Experience with medical billing 

  • Excellent organizational, problem-solving, time management and interpersonal skills 

  •  Clear and concise communication 

  • Ability to follow directions and meet deadlines 

  • Must be able to work in a fast paced, ever-changing work environment 

  • Acts ethically and honestly and applies those behaviors to daily work activities 

  • Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle  

  • Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively 

  • Excellent computer skills including Excel, Word, and Internet use  

  • Ability to multitask and remain focused while managing a high-volume, time-sensitive workload  

  • Basic Medical terminology  

 

Duties: 

  • Ensures the accuracy of patient demographic and insurance information, updating as necessary 

  • Collects, verifies and communicates necessary information with member’s insurance carrier to obtain referrals/authorizations, etc. 

  • Verifies eligibility and health benefits using various websites 

  • Enters insurance information & benefits information in the EHR 

  • Adheres to HIPAA privacy and confidentiality regulations and guidelines 

  • Training all new employees in insurance verification for Family Care & Specialty Clinics using Availity, Ky Health Net & Passport OneSource, etc. 

  • Support for Patient Access as needed (including Sleep Lab Clinic) 

  • Insurance Policy & Financial Counseling – (explaining policy on Ortho surgical patients) 

  • Coordinate Self Pay Discounts & Qualifications  

  • Review chart documentation to ensure patient meets medical policy guidelines 

  • Obtain prior authorization via payer website or by phone and follow up regularly on pending cases 

  • for pre-cert 

  • Prioritize incoming authorization requests according to urgency 

  • Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations 

  • Collaborate with business office on appeals for denied authorizations  

  • Respond to clinic questions regarding payer medical policy guidelines  

  • Contact patients to discuss authorization status for pre-certs 

  • Provide requested medical records to payers 

  • Communicate and educate providers and clinical staff on medical policies 

  • Other duties and tasks may be assigned as appropriate or necessary 

Qualifications


Education Requirements: 

  • High School diploma or equivalent

  • 2 years required insurance verification experience  

  • 2 years clinical office setting 

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