Authorization and Referral Coordinator

Who We Are:

At Panorama Eyecare, we are not just a team; we are a community of dedicated professionals united in our quest to provide the best eyecare anywhere. Our unflinching commitment to excellence and our core values are what make us an Employer of Choice. Join us in shaping the future of eyecare as we thrive together!

The Position:

The Authorization and Referral Coordinator plays a vital role in ensuring that all necessary authorizations and referrals are obtained before the date of service. This position requires close coordination with healthcare providers, insurance companies, and patients to ensure compliance with payer requirements, reduce claim denials, and create a seamless patient experience.

Responsibilities:

Authorization Management:

• Verify the need for prior authorization for scheduled procedures, diagnostic tests, and specialty services based on insurance requirements.
• Submit authorization requests with complete and accurate documentation.
• Monitor authorization status and follow up with payers to ensure timely approvals.
• Communicate authorization outcomes to patients, providers, and scheduling staff.

Referral Coordination:

• Confirm referral requirements based on patients’ insurance plans and provider contracts.
• Request and obtain referrals from primary care providers (PCPs) or referring specialists.
• Track referral approvals and ensure proper documentation in the EHR system.

Patient Communication:

• Inform patients of any authorization or referral requirements before their appointments.
• Provide updates on pending or denied authorizations and assist with next steps.
• Educate patients on insurance processes and address any concerns related to authorizations or referrals.

Collaboration with Internal Teams:

• Work closely with scheduling, clinical, and billing teams to prevent delays due to authorization or referral issues.
• Assist medical billers in resolving claims denied for lack of prior authorization or referral.
• Provide updates on payer requirements and changes in authorization or referral processes.

Documentation and Reporting:

• Accurately document all authorization and referral activities in the EHR system.
• Maintain logs and generate reports on authorization and referral metrics.
• Ensure compliance with HIPAA and organizational policies for handling patient information.

Problem Resolution:

• Address authorization and referral challenges, such as incorrect coding or missing documentation.
• Escalate complex cases to supervisors as needed.

Performance/Skills Requirements:

• Insurance Knowledge: Strong understanding of Medicaid, Medicare, and commercial payers' policies.
• Technical Skills: Proficiency in EHR and practice management systems, as well as knowledge of CPT, ICD-10, and HCPCS codes.
• Communication: Excellent verbal and written communication skills for interacting with patients, providers, and insurance companies.
• Problem-Solving: Ability to address and resolve authorization and referral issues efficiently.
• Attention to Detail: Strong organizational skills to manage high-volume workflows accurately.

Education/Certifications/Experience:

• High school diploma or GED required; Associate’s degree in Healthcare Administration, Business, or related field preferred.
• Minimum 2 years of experience in prior authorization, referrals, or healthcare administrative support.
• Certification in medical billing or coding (e.g., CPC, CCA) is preferred.
• Experience with payer portals and authorization tools is a plus.
• Experience with NextGen a plus.

Additional Details:

• This is a Full-Time position located in Colorado.
• This position is located at 2809 E. Harmony Rd Suite 130 Fort Collins, CO 80528.
• Compensation for this role will be $19.99 – $22.41 an hour based on experience and qualifications.

The Perks:

• PTO Accruals Start at 3 Weeks
• Comprehensive Medical and Dental Insurance
• Company-Paid Optical Allowance
• Company-Paid Routine Eye Care
• Short-Term and Long-Term Disability Insurances
• Educational Allowance
• Paid Holiday Program
• 401K with Company Match

Join Our Team!

Embark on a rewarding journey with Panorama Eyecare and become part of a team that embodies the values of Partnership, Engagement, Excellence, and Stewardship. As an Eyecare Professional, you will not only provide exceptional patient care but also shape the future of our practices. Together, we are transforming the eyecare landscape. Click "apply" now and let your passion for excellence and patient well-being shine!

EEOC:

Panorama Eyecare is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any characteristic protected by law.