The Referral/Pre-Certification Coordinator Verifies and updates patient registration information in Epic. Obtains benefit verification and necessary authorizations (referrals, precertification) prior to patient arrival for all ambulatory visits, procedures, injections, and radiology services. Act as liaison between health plan and physician and/or clinic staff regarding patient complaints and patient non-compliance.
Effectively communicate, collaborate, and interact with patients\plan members, multiple levels of internal personnel and external customers. Use complete knowledge of various insurances and stays current on constantly changing requirements, contracted plans, and any other pertinent information pertaining to referrals. Utilize online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility.
Create appropriate referrals to attach to pending visits. Verify patient demographic information and insurance eligibility including coordination of benefits; update and confirm as necessary to allow processing of claims to insurance plans. Complete chart prepping tasks daily to ensure smooth check-in process for the patient and clinic.
Research all information needed to complete registration process, obtaining information from clinicians, ancillary services, and patients. As needed, fax referral/authorization form(s) to PCPs and insurance companies in a timely manner. Review and notify front office staff of outstanding patient balances.
Maintain satisfactory productivity rates and ensure the timeliness of claims reimbursement while maintaining work queue goals. Responsible for handling the collection and documentation of patient referrals from BHMA physicians for specialist care to obtain the necessary approval, preauthorization, precept, or referral from the managed care companies or other parties requiring authorization. Respond to In-house clinician and support staff questions, requests, and concerns regarding the status of patient referrals, care coordination or follow-up status.
Identify and communicate trends and/or potential issues to management team. Index referrals to patient accounts for existing patients. Create new patient accounts for non-established patients to index referrals.
Various duties as they arise.
Education/Experience: Required – High School Graduate and 2 years' prior experience in the medical field. Knowledge/Skills Abilities: Excellent phone etiquette - verbal, written and listening skills. Must have strong customer service skills, demonstrating tact and sensitivity in stressful situations.
Knowledge of medical terminology and CPT, HCPCS and ICD coding. Prior experience utilizing electronic medical records. Ability to maintain confidentiality and observe HIPAA compliance.
Be able to process 60-80 referrals daily. Preferred: Associates Degree or bachelor's degree in Healthcare or Business-related field. Work
Day On Call: No Weekends: No
No Travel Shift Details: 8a-5p City/State: Johnson City, TN Location: Ballad Health Corporate