Job title Referral Coordinator (COC)
Reports to: Billing Manager
Job purpose
The primary purpose of this position is to contact insurance companies to ensure prior approval requirements are met for continuation of care for each patient visit. Also, this position must assemble information concerning patients' referral/authorization needs and maintain the EMR system with this information.
Essential Duties and Responsibilities
Eligibility Verification
- Verify patient insurance eligibility and benefits prior to scheduled appointments.
- Ensure all insurance information is accurate, complete, and up to date to reflect active coverage.
- Review insurance plans for copays, deductibles, out-of-pocket amounts, referral requirements, and authorization requirements.
- Confirm active coverage, Primary Care Provider (PCP) assignments, and health plan information.
- Update the Electronic Health Record (EHR) with any changes to insurance plans, member IDs, PCP assignments, or coverage status.
- Communicate with patients regarding insurance issues, eligibility concerns, or required documentation.
- Perform monthly Medi-Cal eligibility checks on the first business day of each month to verify active coverage, assigned health plans, PCP information, and any changes that may impact referrals, authorizations, or scheduled appointments.
- Notify appropriate departments of any insurance or coverage changes that may affect patient care, scheduling, or billing.
COC Referrals, Authorizations & Patient Billing Support
- Submit, track, and follow up on Continuity of Care (COC) referrals and authorization requests.
- Ensure all referrals and authorizations are obtained prior to patient appointments whenever possible.
- Follow up with insurance companies, PCP offices, and patients regarding pending referrals or authorizations.
- Review referrals and authorization requests for completeness, accuracy, and compliance with payer requirements.
- Answer incoming patient billing calls and assist patients with questions regarding account balances, insurance processing, referrals, authorizations, and Continuity of Care (COC) status.
- Review patient accounts to explain insurance benefits, copays, deductibles, coinsurance, and patient responsibility amounts.
- Assist patients in understanding billing statements and insurance denials related to referrals, authorizations, or insurance coverage.
- Serve as a liaison between patients, insurance companies, PCP offices, and the billing department to resolve issues related to insurance coverage, referrals, authorizations, and billing.
- Coordinate with the billing department to resolve patient account issues and ensure timely follow-up.
- Document all communications, status updates, patient interactions, and actions accurately within the Electronic Health Record (EHR).
- Maintain organized and accurate records of referral, authorization, and patient billing inquiries.
- Escalate urgent referral, authorization, or billing issues that may delay patient care or reimbursement.
General Responsibilities
- Work collaboratively with, front office staff, billing, and clinical teams to ensure a seamless patient experience.
- Maintain patient confidentiality and comply with all HIPAA regulations and company policies.
- Provide exceptional customer service to patients, providers, insurance representatives, and referring offices.
- Assist with other administrative duties and special projects as assigned.
- Identify, communicate, and escalate issues that may delay patient care, referrals, insurance approvals, or reimbursement.
- Maintain knowledge of insurance guidelines, referral requirements, Continuity of Care processes, and regulatory changes affecting patient eligibility and authorizations.
This position requires an individual who can independently manage their workload, prioritize tasks effectively, and perform efficiently within established time constraints. The individual must be able to communicate effectively with multiple internal departments and ensure that accurate, timely information regarding referral and authorization approvals is relayed so that the appropriate services can be provided during each patient visit.
Job Type: Full-time
Pay: From $21.00 per hour
Expected hours: 80.0 per week
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Disability insurance
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Experience:
- Insurance verification: 1 year (Required)
Work Location: In person
