Mandatory Referral and Eligibility Coordinator

Delphi Technologies; Peoria (AZ); On-site; USD 38,000 - 52,000; Full time

Benefits offered by this job

Company-paid holidays

401(k) retirement plan

Medical coverage option

Dental & Vision

Paid Time Off

Job summary

Cardiac Solutions is seeking a Mandatory Referral and Eligibility Coordinator to obtain referrals from PCPs and authorizations from insurance for visits, tests, and procedures. You will verify insurance, apply plan information, and inform patients of out-of-pocket costs. Overtime is expected January–March each year.

This role requires knowledge of HIPAA, medical terminology, and strong customer service skills in a fast-paced clinic setting.

Qualifications

• Detail oriented and accurate.
• Excellent verbal and written communication skills.
• Excellent customer service skills.
• Familiar with medical terminology.

Responsibilities

• Obtain and verify applicable mandatory referrals on file.
• Verify Primary and Secondary insurance plans.

Skills

Microsoft Office

HIPAA

Medical insurances

Multi-line telephone

Confidentiality

Fast-paced environment

Job description

Mandatory Referral and Eligibility Coordinator

Category Billing

The leading cardiology group in the West Valley is expanding and looking to add valuable and skilled team members to our comprehensive and long-standing Practice.

Cardiac Solutions provides a personalized, team-oriented approach to patient care by promoting wellness through education, innovation, and technology. We offer intensive educational opportunities for patients through our disease management clinics and employ a multidisciplinary approach. All team members play a vital role in providing our patients with tailored care and support services. Our focus helps to prevent the progression of heart disease and minimize hospital admissions for our patients.

• Competitive wages
• Uniform/Scrub Allowance
• Monday – Friday for most positions
• 7 Company Paid Holidays*
• Employee Medical coverage option as low as $25.00 per paycheck*
• Dental & Vision*
• Supplemental coverage options to include Life/AD&D, Short-Term, Long-Term, Critical Illness, Hospital, Accidental*
• 401(k) retirement plan
• Paid Time Off*
• Paid Sick Time
• Employee Assistance & Discount Programs

*Available to full-time, regular employees* - ** Restrictions may apply **

POSITION SUMMARY:

Responsible for obtaining referrals from primary care physicians (PCP) and authorizations from insurance companies for office visits, testing and hospital procedures when the plan requires authorizations. Verifies insurance and applies correct plan information in patient’s accounts. Notifies patients of out of pocket responsibility for testing and procedures. This position is typically required to work mandatory overtime January through March of each calendar year. Please note that the overtime may be changed, modified or canceled at any time with or without notice.

ESSENTIAL JOB DUTIES:

• Obtains and verifies that applicable mandatory referrals are on file.
• Verifies Primary and Secondary insurance plans.
• Verifies and updates patient registration information in the practice management system.
• Create new patient accounts for non-established patients.
• Obtains benefit verification and necessary authorizations /referrals prior to patient arrival for all visits.
• Creates appropriate referrals/cases to attach to pending visits.
• Uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
• Fax referral form to PCPs for office visits in timely fashion.
• Manages both internal and external incoming calls to the department
• Consistently seeks resources to stay informed on changing authorization requirements for testing and procedures.
• Other duties and tasks assigned as appropriate or necessary.

Position Requirements

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of Microsoft Office products.
• Knowledge of HIPAA regulations.
• Knowledge of medical insurances.
• Skill with working with multi-line telephone system.
• Skill in working with outside facilities.
• Ability to maintain confidentiality and professionalism.
• Ability to work in a fast paced-environment and work well under pressure.

EDUCATION AND/OR EXPERIENCE:

• Minimum of one-year medical eligibility/referral/authorization experience.
• Detail oriented.
• Excellent verbal and written communication skills.
• Excellent customer service skills.
• Medical terminology.

PHYSICAL DEMANDS/WORK ENVIRONMENT:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the following physical/work environment functions apply:

• Sit, stand, bend, lean, talk, and hear for extended periods of time.
• Type, utilizing a computer keyboard and maneuvering a computer mouse.
• May lift up to 25 lbs.
• Utilize a multi-line telephone system.

Full-Time/Part-Time Full-Time

Shift Days

Travel Requirements

Exempt/Non-Exempt Non-Exempt

Location Peoria Office

About the Organization Cardiac Solutions is a medical, physician-owned business that provides a comprehensive range of cardiac health services to the general public and referred patients. Founded in 1984 by Dr. Joseph Caplan, our clinics have established a solid reputation for innovative cardiology treatments and personalized cardiovascular care. We are proud of our status as the West Valley's leading cardiology team, specializing in YOUR total heart care. Our board-certified cardiologists always put your treatment and care first, allowing you to have the peace of mind knowing that your heart is in good hands.
With our intensive educational opportunities through nurse-directed clinics, we help prevent the progression of heart disease by offering extensive cardiology testing. Our main goal is to avoid hospital admissions by accurately diagnosing and treating cardiac problems at the earliest possible stage. During this process, you not only build a relationship with your physician, but with the many members of our TEAM, all of whom are focused on YOUR heart health.

EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.

This position is currently accepting applications.