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 eligibility. · 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 goals. · 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. EDUCATION · High school diploma/GED or equivalent working knowledge preferred. EXPERIENCE · 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. · Working knowledge of Centricity Practice Management and Centricity EMR a plus. REQUIREMENTS · Must have healthcare experience with managed care insurances, requesting referrals, authorizations for insurances, and verifying insurance benefits. · In-depth knowledge of insurance plan requirements for Medicaid and commercial plans. KNOWLEDGE · Working knowledge of eligibility verification and prior authorizations for payment from various HMOs, PPOs, commercial payers, and other funding sources. · Knowledge of government provisions and billing guidelines including Coordination of Benefits. · Advanced computer knowledge, including Window based programs. SKILLS · Skilled in defusing difficult situations and able to be consistently pleasant and helpful. · Skill in using computer programs and applications. · Skill in establishing good working relationships with both internal and external customers. ABILITIES · Ability to multi-task in a fast-paced environment. · Must be detailed oriented with strong organizational skills. · Ability to understand patient demographic information and determine insurance eligibility. · Ability to type a minimum of 45 wpm. ENVIRONMENTAL WORKING CONDITIONS · Normal office environment PHYSICAL/MENTAL DEMANDS · Requires sitting and standing associated with a normal office environment. · Some bending and stretching are required. · Manual dexterity using a calculator and computer keyboard. ORGANIZATIONAL REQUIREMENTS · HOPCo Mission, Vision, and Values must be acknowledged and adhered to.