Referrals and Precertification Coordinator

Retina Consultants of Texas; Houston (TX); On-site; USD 38,000 - 48,000; Full time

Benefits offered by this job

Medical, dental, and vision coverage

401(k) retirement savings with company

Job summary

Retina Consultants of Texas is seeking a Referral and Precertification Coordinator to obtain benefit verifications, referrals, and authorizations for ambulatory visits, procedures, and injections.

This full-time role supports our network of 25+ locations and collaborates with patients, carriers, and physicians to ensure timely approvals and seamless care coordination.

Qualifications

• High School Diploma or GED required. Bachelor’s Degree preferred.
• Minimum two to three years of experience in a healthcare environment in a referral, front desk or billing role.
• Healthcare experience with Managed Care Insurances, requesting Referrals, Prior Authorizations for Insurances and verifying Insurance benefits preferred
• In-depth knowledge on insurance plan requirements for Medicaid and commercial plans preferred.

Responsibilities

• Obtains benefit verification and necessary authorizations (referrals, precertification) prior to patient arrival for all ambulatory visits, procedures, injections and radiology services.
• Uses Web IVR to generate authorizations and referrals (Availity, Optum, and any other approved web IVR for authorization processing).
• Obtain recertification for cases requiring extended treatment/coverage beyond the expiration of original approval.
• Creates appropriate referrals to attach to pending visits.
• 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.
• Respond to In-house provider and support staff questions, requests and concerns regarding the status of patient referrals, care coordination and authorization status.
• Participate in Call Center Activities, triage and respond to incoming calls from patients, insurance companies, and physicians. May serve as single point of contact for an assigned group of prescribers.
• Educate patients, prescribers, and others regarding program requirements, and facilitate referrals. Maintain good housekeeping techniques, adhering to quality and production standards and comply with all applicable company, state, and federal safety and environmental programs and procedures.
• Identifies and communicates trends and/or potential issues to management team.
• Performs other related duties as assigned.

Skills

Healthcare experience

Front desk experience

Call center experience

Education

High School Diploma or GED

Bachelor's Degree preferred

Tools

Availity

Web IVR

Insurance verification software

Job description

Overview

Retina Consultants of Texas (RCTX) is seeking a Referral and Precertification Coordinator will be responsible for obtaining benefit verifications, referrals, and authorizations for ambulatory visits, procedures, and injections.

Retina Consultants of Texas is the largest and most respected retina-only ophthalmology practice in the United States. Our group consists of 26 world-renowned physicians leading the world in retinal care. While serving two major metropolitan markets (and their extensions) our combined culture allows us to best serve our patients, referral sources and our own team of physicians. RCTX also invests heavily in diagnostic equipment, providing state-of-the-art retina imaging, laser, and diagnostic capabilities to each patient. This, combined with the clinical expertise of our physicians, an outstanding and devoted staff, and 25 convenient locations to serve our patients.

We worked hard to create our culture as Retina Warriors. We strongly emphasize our core values of Hard Work, Authentic Care and Innovation in everything we do. It is our belief that by investing in our people, our people will be empowered of their own accord to provide the highest quality patient experience.

Benefits

In addition to being highly challenged professionally, in joining our practice, the following competitive benefits for full-time eligible employees after a 60-day introductory period:

• Employee Paid Benefits such as Medical, Dental, and Vision, short-term disability, voluntary life insurance, accident, critical illness, hospital indemnity, pet insurance, HSA pre-taxed contributions, 401 (k) retirement savings contributions (both Roth and Traditional options) from starting date of hire.
• Employer Paid Benefits such as long-term disability, $25,000 basic life insurance policy, 3% 401(k) safe harbor contribution, HSA employer contributions, annual performance merit increases, certification opportunities, rewards & recognition platform, WellHub Starter Plan Gym Membership, paid time off and (8) paid holidays + (1) floating holiday annually.

RCTX is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, age, national origin, disability, military service, veteran status, genetic information, or any other protected class under applicable law.

Responsibilities

• Obtains benefit verification and necessary authorizations (referrals, precertification) prior to patient arrival for all ambulatory visits, procedures, injections and radiology services.
• Uses Web IVR to generate authorizations and referrals (Availity, Optum, and any other approved web IVR for authorization processing).
• Obtain recertification for cases requiring extended treatment/coverage beyond the expiration of original approval.
• Creates appropriate referrals to attach to pending visits.
• 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.
• Respond to In-house provider and support staff questions, requests and concerns regarding the status of patient referrals, care coordination and authorization status.
• Participate in Call Center Activities, triage and respond to incoming calls from patients, insurance companies, and physicians. May serve as single point of contact for an assigned group of prescribers.
• Educate patients, prescribers, and others regarding program requirements, and facilitate referrals. Maintain good housekeeping techniques, adhering to quality and production standards and comply with all applicable company, state, and federal safety and environmental programs and procedures.
• Identifies and communicates trends and/or potential issues to management team.
• Performs other related duties as assigned.

Qualifications

• High School Diploma or GED required. Bachelor’s Degree preferred.
• Minimum two to three years of experience in a healthcare environment in a referral, front desk or billing role.
• Healthcare experience with Managed Care Insurances, requesting Referrals, Prior Authorizations’ for Insurances and verifying Insurance benefits preferred
• In-depth knowledge on insurance plan requirements for Medicaid and commercial plans preferred.