Referral and Authorization Coordinator

At HOPCo, 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

QUALIFICATIONS

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

ESSENTIAL FUNCTIONS

• Verifies and updates patient registration information in the practice management system.
• Obtains benefit verification and necessary authorizations (referrals, precertification) before 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
• 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 a smooth check-in process for the patient and clinic.
• Researches all information needed to complete the 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 daily. For primary
• specialty office visits, fax referral/authorization forms 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
• 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 the management team.
• Index referrals to patients account for existing patients.
• Create new patient accounts for non-established patients to index referrals.

The Referral and Authorization Coordinator is responsible for completing the pre-registration, registration, eligibility verification, verification of benefits, and pre-certification/documentation processes which involves communicating with patients, primary care physician offices, and insurance companies to ensure that all appropriate demographic and reimbursement information is accurate prior to the patient’s scheduled appointment.

Healthcare Outcomes Performance Company is a vertically integrated musculoskeletal outcomes management company. HOPCo manages physician practices, hospital service lines, population health and value-based care programs, and musculoskeletal delivery networks.

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