What are the responsibilities and job description for the Referral and Eligibility Coordinator position at Mid-Atlantic Nephrology Associates PA?
Summary: Perform all activities associated with gathering, verifying, applying and maintaining accurate patient demographic and insurance information, for all service lines (office new, dialysis, hospital), at a satisfactory level of quality and productivity. Responsible for ensuring appropriate and effective authorizations and referrals are on file for all charges.
a. The R&E Coordinator is responsible for the quality, accuracy and completeness of demographic information
b. Performs insurance verifications as indicated by company policy by utilizing online websites, sources, payer sites, and other tools
c. Understands the impact of how this role affects the performance of the revenue cycle as well as the client experience
d. Ensures that the verification of eligibility, the coordination of benefits, the procurement of referrals and authorizations are performed proactively and prior to the patient visit and/or claim generation
e. Becomes the subject matter expert as it relates to carrier requirements and accurate demographic entries
f. Accurately and completely enters information into the Practice Management and Verification Systems (eligibility field) as designated by policy
g. Demonstrates knowledge of importance of referring physician and other critical information and is diligent in gathering information
h. Utilizes various information sources for patient demographic and insurance information such as but not limited to referring physician office, hospital’s patient accounting department and patient
i. Processes insurance discovery when patient reports as self-pay
j. Utilizes all tools to research for payer prior to reporting balance to collection agency
k. Work assigned EHR tasks, e-mails and Work Queues.
2) Interacts with the patient and others in a professional manner.
a. Demonstrates confidence and speaks appropriately with patients in gathering information
b. Explains COB guidelines to patients as needed
c. Works collaboratively with all revenue cycle departments to provide the optimal client and patience experience
3) Provides support to others.
a. Can handle multiple tasks at once
b. Attend and actively participate in individual, group and department meetings
c. Provide back-up as required to ensure all intake deadlines are met
d. Other duties as assigned
This job has no supervisory responsibilities.
To perform the job successfully, an individual should demonstrate the following competencies:
• Adaptability
• Initiative
• Judgment
• Verbal and Written Communication
• Professionalism
• Teamwork approach
Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education/Experience:
High school diploma or general education degree (GED); or two to four years related experience and/or training; or equivalent combination of education and experience.
Reasoning Ability:
Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.
Computer Skills:
To perform this job successfully, an individual should have knowledge of Word Processing software, Spreadsheets, E-Mail, Medical Manager, and Internet Software.
We offer a competitive salary commensurate with experience and a robust benefit package including health, dental, vision, Short Term Disability, Long Term Disability, Group Term Life, PTO, paid holidays, and 401(k) plan with generous employer contribution.
Prospective employees must pass a criminal background check.
Salary : $38,000 - $48,000
