Referral Coordinator
**Prior referral coordination experience is a requirement
**In-person role, no remote option
**Must be able to work 40 hours a week, and make the commute
GENERAL SUMMARY
Responsible to gather charge information, maintain the insurance database, distribute insurance claims, and assist patients with insurance and self-pay billing problems. Additionally, the Patient Accounts Representative processes data and information to facilitate maximum and timely payments.
ESSENTIAL JOB FUNCTIONS*
- Verification of patient insurance plans using multiple insurance websites: i.e. Change Healthcare: Trizetto Provider Solutions and others
- Maintain ongoing tracking of referrals and appropriate documentation using our Practice Management system
- Knowledge regarding insurance and referral policies and guidelines
- Able to Multitask will maintaining a high level of accuracy
- Strong work ethics background
- Team oriented and be able to work independently
- Strong computer skills including Excel, Microsoft Outlook, and Word
- Maintain a professional and respectful attitude
- Multitask using multiple computer monitors
- Generate reports on a daily bases
- Knowledge pertaining to copayment tiers
- Time management skills
- Manage insurance referral books
- Communicate with patients, insurance representatives, primary care offices regarding missing referrals and insurance demographics
- Attend in-person or virtual insurance webinars
Ø Responsible for clean claim submission.
Ø Approves and transmits EDI claims.
Ø Works EDI response reports to correct transmission errors from carriers.
Ø Researches all information needed to complete billing process. This includes working directly with physicians, referral coordinator and reception.
Ø Code information about procedures performed and appropriate diagnosis for services.
Ø Audit and edit daily batches and data to produce clean claims. Reconciles charges.
Ø Posts payments, adjustments, and transfer balances as required.
Ø Carries out research and follow up regarding accounts requiring additional documentation. Manages and works receivable accounts.
Ø Assists with coding and error resolution.
Ø Handles patient questions, on-site and by telephone, regarding problematic accounts.
Ø Pre-authorizes surgeries, medications and other procedures with third party payers as necessary.
Ø Collects prior authorizations requests initiated by physicians.
Ø Initiates prior authorization request to patient’s Insurance carrier.
Ø Work with patients for medication requests.
Ø Initiates letters of medical necessity from physicians.
Ø Participates in educational activities.
Ø Maintains strictest confidence.
Ø Maintains current knowledge of policies and procedures, as well as updated ICD-10 and CPT-4 coding and billing compliance knowledge.
Ø Must keep patient and business confidentiality at all times; follows HIPAA policies for patient privacy and has access to Level 2,3,4 PHI. Complies with OSHA and AAHC policies and procedures.
Ø Performs clerical and any other duties as directed by Manager.
PREPARATION, KNOWLEDGE, SKILLS & ABILITIES
Ø High School diploma or equivalent. Associates or Bachelors degree in business preferred.
Ø Five plus years of medical office billing or administrative experience.
Ø Knowledge of billing software, billing and compliance policies, and of third party billing and claims/collection procedures.
Ø Must possess a calm, reassuring, competent demeanor and the ability to be sensitive to patient needs, as well as maintain a positive and friendly attitude when dealing with difficult patients.
Ø Must have the ability to examine documents for accuracy, completeness and pay attention to detail.
Job Type: Full-time
Pay: $22.00 - $24.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Vision insurance
Weekly day range:
Application Question(s):
- Are you able to show up on time Monday to Friday during normal business hours for this job?
- Are you able to reliably make the commute to Chestnut Hill for this job without issue?
- Prior referral coordination experience, including knowledge of navigating different insurance website, and use of athenahealth is a requirement for the job. Do not apply if you do not qualify for the above. Please answer this question with "Understood" if you qualify after reading the above information.
Experience:
- Referral Coordinator: 1 year (Required)
Job-related location requirement:
- Candidates must be within a 25-mile radius.
Work Location: In person