What are the responsibilities and job description for the Authorization and Referral Specialist - Front Office Coordinator position at West Coast Pulmonary Physicians, Inc?
The Referral and Authorization Specialist - Front Office Coordinator is responsible for effectively coordinating outside referrals from referring providers, submitting authorizations and coordination of referrals for outside services while supporting the front office in a busy Pulmonary practice.
Duties:
-Coordinate and facilitate the Authorization and Referral process for patients in a medical office setting
-Receives referral requests from providers and Health Plans representatives. Assists in processing medical services request and scheduling of new patients
-Obtain and verify insurance information for patients, ensuring eligibility and coverage for referred services
-Scans, attaches, reviews and effectively works with electronic records as part of the authorization process, ensures accuracy and completeness of referral documentation
-Communicate with patients, healthcare providers, and insurance companies regarding referral status and updates
-Maintain confidentiality of patient information in accordance with HIPAA regulations
-Maintain accurate and up-to-date records of all referrals, authorizations, and related documentation.
-Collaborate with medical staff to ensure appropriate referrals are made based on patient needs and medical guidelines.
-Assist patients in scheduling appointments with referred providers, ensuring seamless coordination of care.
-Provide education to patients regarding their referral process, including any required pre-authorization or pre-certification steps.
Experience:
- Minimum of 2 years of experience in a medical office or healthcare setting.
- Proficiency in medical terminology, ICD-9, ICD-10 coding, and insurance verification processes.
- Familiarity with medical records management and documentation requirements. - Strong attention to detail and accuracy in data entry and record keeping.
- Excellent communication skills, both written and verbal, with the ability to effectively interact with patients, healthcare providers, and insurance companies.
- Ability to prioritize tasks and manage multiple referrals simultaneously in a fast-paced environment.
Front Office Responsibilities:
Answering phones call and transferring to to appropriate extension
Schedule new patient consults, hospital follow ups and returning patients
Check patients eligibility for every patient encounter. Benefits are confirmed through electronic or phone contact with the insurance provider
Check-in patients for in office visits, collect new patient paperwork, scan into chart
Send referral information to patient's PCP
Contact payer to obtain prior authorization. Gather additional clinical and/or coding information, as necessary, in order to obtain prior authorization. Enter prior authorization information into Nextgen to ensure accurate and timely claims filing
Collect co-payments
Serve as the primary resource to patients regarding the prior authorization process. Explain requirements, terminology, billing process, consent requirements, collect insurance info, etc., as necessary
Assist back office and administration when necessary
Requirements:
High school diploma, some college preferred
Previous medical Front Office experience required
Bilingual in English / Spanish required
Knowledge and understanding of co-insurance, co-payments, deductible, and out-of-pocket expenses
Knowledge of Medicare, Medicaid, HMO, PPO, advantage plans and guidelines highly desired
Proficiency in PC software, especially word processing and spreadsheet programs
Experience with patient billing software preferred; Nextgen software particularly helpful
Effective communication skills, both written and verbal
Ability to meet deadlines
Ability to multi-task and problem solve
Strong organizational skills
Effective interpersonal skills
Note: This job description is not intended to be all-inclusive. The employee may perform other related duties as assigned by their supervisor.
Job Type: Full-time
Pay: $19.00 - $23.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Weekly day range:
- Monday to Friday
Work Location: In person
Salary : $19 - $23