Insurance Authorization Coordinator Jobs in Spring, TX

"Sanitas is a global healthcare organization expanding across the United States. Our services include primary care, urgent care, nutrition, lab, diagnostic, health care education and resources for ourpatients. We strive to attract professionals who believe in our mission, vision and are dedicated to the service of ourpatients and their families creating a memorableexperiencethrough compassion, respect,and kindness."

Job Summary

The purpose of the Referral Coordinator position is to manage and facilitate the process of referring patients to other healthcare providers or services, ensuring that patients receive the appropriate care and services they need. This includes responsibilities such as following referral procedure guidelines, obtaining prior authorization as needed by health plans, processing referrals, and scheduling appointments to specialists for patients per provider requests. Referral Coordinators play a crucial role in maintaining the continuity of care within the healthcare system.

Essential Job Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Training and Education: Staying updated on healthcare regulations, insurance requirements. Providing training and education to other staff members as needed.
• Assessment and Evaluation: Reviewing patient records and assessments. Assessing the specific requirements of the patient's condition.
• Communication and Liaison: Collaborating with referring healthcare providers. Communicating with specialists or service providers.
• Insurance Verification and Authorization: Verifying patient insurance coverage for the referral services. Obtaining necessary pre-authorization or precertification from insurance providers.
• Documentation and Record Keeping: Maintaining accurate and organized records of all referrals, including relevant details. Must enter and update referral data in the electronic system as appropriate. Documenting the reasons for the referral, dates, and specialist information.
• Patient Education and Support: Explaining the referral process to patients, including reasons for the referral and what to expect.
• Problem-Solving and Issue Resolution: Resolving any challenges or obstacles that may arise during the referral process.
• Compliance and Privacy: Ensuring the referral process complies with healthcare regulations and privacy policies, such as HIPAA.

Supervisory Responsibilities

This position has no supervisory responsibilities.

Required Education

• High school diploma or equivalent.

Required Experience

• Minimum requirement of one year work experience with referrals, or related medical office experience. Experience with EMR systems is preferred.

Required Licenses and Certifications

• N/A

Required Knowledge, Skills, and Abilities

• Proficient with Microsoft Office Suite or related software.
• Excellent verbal and written communication skills.
• Excellent customer service skills.
• Excellent organizational skills and attention to detail.

Preferred Qualifications

• Experience with EMR systems preferred.

Financial Responsibilities

Budget Responsibilities

Languages

Travel

Physical Demands

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.

Includes all patient-facing clinical staff ( Medical Assistants, Phlebotomists, Mammography Technologists, Radiologic Technologists, Multi-Specialty staff, Providers) as well as Facilities Technicians. These positions typically require prolonged standing and walking, frequent bending, reaching, lifting, pushing, and pulling of equipment or supplies (up to 50 pounds), manual dexterity, and compliance with infection control and safety protocols. Facilities Technicians may also perform repairs, renovations, remodeling, preventive maintenance, and use tools and equipment to support our medical centers.

Environmental Conditions

Inside: The employee is subject to environmental conditions, protection from weather conditions but not necessarily from temperature changes. The worker is subject to noise; there may be sufficient noise to cause the worker to shout in order to be heard above ambient noise level.

Physical/Environmental Activities

Please indicate with an X the frequency for the activities that apply to the essential functions of the job based on the chart below. Please select Not Required for physical demands that aren't essential to job performance.