Job Description

A Healthcare Client has a Remote or Onsite Contract Opportunity for an Authorization Referral Coordinator due to a peak in census. expected 6-month contract with possibility of extension. Onsite candidates may have an advantage for consideration. Schedule is M-F, 8:30-5pm. REMOTE CANDIDATES must live in CA. 

Responsible for performing appropriate processes to verify patient eligibility, coordinate benefits, ensure insurance coverage, and determine if prior authorization is needed for order. If needed, obtain authorization for test, therapies or referral to specialist and document in patient electronic medical record. Will facilitate responses to patient and provider inquiries regarding authorizations and referrals within turnaround standards.

• Monitor and resolve referral/authorization orders in the Referral Pool in Epic in a timely manner
• Monitor daily urgent and pending referrals to ensure timeliness standards are met and customer service is maximized according to standard workflows
• Ensure completeness/accuracy of referrals by confirming CPT, ICD and/or HCPCS codes, requested provider, and/or place of service
• Verify insurance is accepted for all incoming referrals
• Obtain added medical information from providers and/or office staff as necessary for incoming referrals
• Process referrals per standard work. Process referrals per health plan contracts and requirements
• Provide medical information to obtain final determinations when required
• Research all no authorization denials and submit for retro authorizations

Requirements:

• High School Diploma or equivalent
• English - Speak, Read, Write
• Epic EMR Experience
• Insurance experience along with Referral and Authorizations
• Experience confirming completeness and accuracy of CPT, ICD and HCPCS codes

Company Description

R.A.M. Healthcare Consulting Group, Inc. – Quality, Service, & Integrity R.A.M. Healthcare Consulting Group has over two decades of combined experience providing consulting services to hospitals throughout the United States. R.A.M HCG has built a solid reputation providing superior customer service and client satisfaction. With quality, service, and integrity as our core values, we specialize in staffing for hospitals nationwide. Our success begins with the right people—a highly trained staff and quality healthcare specialists. We are proud of our consultants and stand by them 100%. We also constantly invest in our staff and provide a great work environment and best-in-class benefits. Find out more about us: www.ramhcg.com