Authorization and Referrals Coordinator

Tasks to include but not limited to: 

Review all provider schedules in advance to confirm that insurance coverage is listed correctly.  Update and confirm eligibility as needed.

Review all provider schedules in advance and obtain Referrals from primary care doctors as needed.

Review all provider schedules in advance and obtain Authorizations for imaging/procedures as needed. 

Confirm that medical necessity requirements are met for high dollar services not requiring authorization.  Review specific insurance medical policies as needed.  If coverage is questionable, prepare ABN forms for patients to sign and make sure the patient is aware of potential out of pocket costs.

Obtain retro-authorizations as needed for hospital services and remote monitoring services as requested.

Respond to patients who have questions about authorizations and referrals.

Assist Billing Team with resolving claim issues in regards to authorizations and referrals.

Ensure that referring PCP information (name, phone number, fax number, NPI number, etc.) is up to date in Athena directory.

Communicate regularly with providers, staff, patients and management to advise on the status of authorizations and referrals.  Recommend rescheduling of service(s) when authorization(s) or referral(s) cannot be obtained in time.

Back up the front desk with check in, check out and scheduling as needed.

Assist with other billing/scheduling tasks as requested.

2 years of experience working with advanced imaging authorizations or surgical procedures is preferred but not a must.