Hybrid Referral Coordinator bei Ohio County Healthcare
Ohio County Healthcare · Hartford, Vereinigte Staaten Von Amerika · Hybrid
- Junior
- Optionales Büro in Hartford
Job Details
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:
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Excellent working knowledge of insurance carriers’ payment regulations, copays, coinsurance and deductibles, in-network and out-of -network providers.
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Knowledge of insurance guidelines; including Medicare, HMO, PPO, & KY Medicaid
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Experience in health insurance verification preferred
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High attention to detail and accuracy
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Experience with medical billing
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Excellent organizational, problem-solving, time management and interpersonal skills
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Clear and concise communication
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Ability to follow directions and meet deadlines
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Must be able to work in a fast paced, ever-changing work environment
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Acts ethically and honestly and applies those behaviors to daily work activities
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Knowledge of procedure authorization and its direct impact on the practice’s revenue cycle
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Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively
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Excellent computer skills including Excel, Word, and Internet use
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Ability to multitask and remain focused while managing a high-volume, time-sensitive workload
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Basic Medical terminology
Duties:
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Ensures the accuracy of patient demographic and insurance information, updating as necessary
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Collects, verifies and communicates necessary information with member’s insurance carrier to obtain referrals/authorizations, etc.
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Verifies eligibility and health benefits using various websites
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Enters insurance information & benefits information in the EHR
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Adheres to HIPAA privacy and confidentiality regulations and guidelines
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Training all new employees in insurance verification for Family Care & Specialty Clinics using Availity, Ky Health Net & Passport OneSource, etc.
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Support for Patient Access as needed (including Sleep Lab Clinic)
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Insurance Policy & Financial Counseling – (explaining policy on Ortho surgical patients)
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Coordinate Self Pay Discounts & Qualifications
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Review chart documentation to ensure patient meets medical policy guidelines
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Obtain prior authorization via payer website or by phone and follow up regularly on pending cases
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for pre-cert
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Prioritize incoming authorization requests according to urgency
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Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations
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Collaborate with business office on appeals for denied authorizations
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Respond to clinic questions regarding payer medical policy guidelines
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Contact patients to discuss authorization status for pre-certs
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Provide requested medical records to payers
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Communicate and educate providers and clinical staff on medical policies
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Other duties and tasks may be assigned as appropriate or necessary
Qualifications
Education Requirements:
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High School diploma or equivalent
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2 years required insurance verification experience
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2 years clinical office setting