Remote Claims Jobs in Rensselaer, NY (NOW HIRING)

Employment Type:
Full timeShift:
Day Shift
Description:
Referral Coordinator-Rensselaer, NY - Full Time
Hybrid Remote: This position requires a minimum of 2 days on site
This position is located at 295 Valley View Blvd Rensselaer, NY.
If you are looking for a position as a Referral Coordinator to support a rapidly growing team this could be your opportunity. Here at St. Peter's Health Partner's, we care for more people in more places.
Position Highlights:

• Quality of Life: Where career opportunities and quality of life converge
• Advancement: Strong orientation program, generous tuition allowance and career development
• Work/Life: Office Hours Monday-Friday

What you will do:
- Properly maintains and tracks referrals from beginning to end. Accountable for the referral loop by tracking all referral orders including but not limited to specialty referrals and diagnostic referrals.
- Answers, responds to and documents phone calls, requests and questions from patients, physicians, ancillary services or specialty offices in a timely manner. Calls must be accurately managed
- Assembles information concerning patient's clinical background and referral needs. Per referral guidelines, provides appropriate documented clinical information to specialists.
- Reviews details and expectations regarding the referral with patients.
- Communicates any prep instructions via documented orders or protocol to patient.
- Receives and reviews referral requests; prioritizes orders based on urgency.
- Schedules, problem solves, communicates, and coordinates referral appointments with patient, physician(s), specialists and/or central scheduling.
- Collaborates with essential care team members including: physicians, mid-level providers, LPN's, MA's, Practice
- Maintains patient confidentiality and abides by all HIPPA guidelines.
Authorizations
- Obtains necessary authorization for referrals and diagnostic testing in timely fashion with proper documentation.
- Works in collaboration with Billing Analyst on denied claims for missing prior authorization or referral within the EMR system.
- Maintains up-to-date knowledge of referral/payer prior authorization requirements, eligibility guidelines and documentation requirements.
- Communicates insurance decisions to patient.
- Conducts follow up calls as necessary to physician offices, patients and payers to complete pre-certification process.
Care Coordination
- Confirms payer is in-network with specialist. If not, contacts patient to discuss and make alternate arrangements as necessary per payer guidelines in communication with the care team.
- Act as point of contact for anything referral related, be the expert in this area for the office(s) you are assigned
Education Requirements:
Minimum Requirement: High School Diploma or equivalent required. BA preferred.
Experience Requirements:
5 yrs minimum experience in a medical office.
Effective written and verbal communication skills.
Knowledge of insurance payers and processes.
Demonstrates attention to detail, organization and effective time management.
Ability to work independently, with little supervision.
Knowledge of ICD-10, CPT, and CPTII codes.
Solid judgement to escalate issues appropriately.
Advanced knowledge of Microsoft office, related computer programs and general office machines.
Ability to communicate effectively with the patient population while exhibiting exemplary customer service skills.
Pay Range: $19.20 - $25.85
Pay is based on experience. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.