- Enter patient referrals accurately and efficiently into the electronic referral portal in accordance with established workflows and timelines.
- Review referral documentation for completeness and follow up with clinical staff to obtain missing information as needed.
- Maintain organized records of all referral activity and update patient records accordingly.
- Contact patients by phone or secure messaging to communicate referral status, appointment scheduling information, or follow-up instructions.
- Document all patient interactions in the electronic health record (EHR) in a timely and accurate manner.
- Verify insurance eligibility and benefits using clearinghouse and payer portals (e.g., TriZetto).
- Identify when prior authorization is required based on payer guidelines and CPT codes.
- Prepare and submit prior authorization requests to payers using online portals, fax, or other payer-specific workflows.
- Track authorizations, follow up on pending or denied requests, and document updates in the patient record systems (EMR and/or Azalea).