Referral and Authorization Coordinator

Established in 2001, Southeast Orthopedic Specialists is a regional leader in orthopedic medicine. We are dedicated to growing with our patients. Our reach will continue to expand to meet the needs of all patients, present and future. It is our wish to make industry-leading five-star orthopedic care accessible to as many people as possible.

At Southeast Orthopedic Specialists, we are dedicated to taking care of you so you can take care of business! Our robust benefits package includes the following:

• Competitive Health & Welfare Benefits
• Monthly $43 stipend to use toward ancillary benefits
• HSA with qualifying HDHP plans with company match
• 401k plan after 6 months of service with company match (Part-time employees included)
• Employee Assistance Program that is available 24/7 to provide support
• Employee Appreciation Days
• Employee Wellness Events

As Southeast Orthopedic Specialists continues to grow, we are looking for a Referral and Authorization Coordinator at our Central Business Office. Please see below for the functions and requirements:

ESSENTIAL FUNCTIONS

• Verifies and updates patient registration information in the practice management system.
• Obtains benefit verification and necessary authorizations (referrals, precertification) prior to patient arrival for all ambulatory visits, procedures, injections and radiology services.
• Uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility.
• Creates appropriate referrals to attach to pending visits.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
• Completes chart prepping tasks daily to ensure smooth check-in process for the patient and clinic.
• Researches all information needed to complete registration process including obtaining information from providers, ancillary services staff and patients.
• Fax referral form to providers that do not require any records to be sent. Be able to process 75-80 referrals on a daily basis. For primary specialty office visits, fax referral/authorization form to PCPs and insurance companies in a timely fashion.
• Reviews and notifies front office staff of outstanding patient balances.
• Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue goals.
• Respond to In-house provider and support staff questions, requests and concerns regarding the status of patient referrals, care coordination or follow-up status.
• Identifies and communicates 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.

EDUCATION

• High school diploma/GED or equivalent working knowledge preferred.

EXPERIENCE

• Minimum two to three years of experience in a healthcare environment in a referral, front desk or billing role.
• Must be able to communicate effectively with physicians, patients and the public and be capable of establishing good working relationships with both internal and external customers.
• Working knowledge of Centricity Practice Management and Centricity EMR a plus.

REQUIREMENTS

• Must have Healthcare experience with Managed Care Insurances, requesting Referrals, Authorizations’ for Insurances and verifying Insurance benefits.
• In-depth knowledge on insurance plan requirements for Medicaid and commercial plans.

KNOWLEDGE

• Working knowledge of eligibility verification and prior authorizations for payment from various HMOs, PPOs, commercial payers and other funding sources.
• Knowledge of government provisions and billing guidelines including Coordination of Benefits.
• Advanced computer knowledge, including Window based programs.

SKILLS

• Skilled in defusing difficult situations and able to be consistently pleasant and helpful.
• Skill in using computer programs and applications.
• Skill in establishing good working relationships with both internal and external customers.

ABILITIES

• Ability to multi task in a fast-paced environment. Must be detailed oriented with strong organizational skills.
• Ability to understand patient demographic information and determine insurance eligibility.
• Ability to type a minimum of 45 wpm.

ENVIRONMENTAL WORKING CONDITIONS

• Normal office environment.

PHYSICAL/MENTAL DEMANDS

• Requires sitting and standing associated with a normal office environment.
• Some bending and stretching required.
• Manual dexterity using a calculator and computer keyboard.

Job Type: Full-time

Pay: $14.00 - $16.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Education:

• High school or equivalent (Preferred)

Experience:

• Customer Service: 1 year (Preferred)
• healthcare: 1 year (Preferred)
• EMR systems: 1 year (Preferred)
• HIPAA: 1 year (Preferred)

Work Location: One location