• Provide internal support to the Medical Management Department in the areas of Outpatient Case Management ensuring all services referred are reviewed according to plan requirements and approved criteria. • Effectively communicates to management and internal departments timely. • Receives and responds to all incoming calls from PCP, specialists, and other providers regarding inpatients, surgeries, and outpatient services including DME, Home Health Care, and other services requiring a pre-authorization. • Coordinates DME with contracted HMO vendors for outpatient services. • Coordinate with Inpatient Case Manager on discharge planning of members (DME, Home Health, and Skilled Nursing). • Coordinates and reviews retro surgical procedures with Manager. • Understands Health Plan policies and procedures regarding pre-authorization, benefits by health plan, and preferred facilities within each plan. • Enters data and coordinates elective admissions with a surgical component. • Maintains compliance with all health plan guidelines on the reporting of cases/surgeries. • Works with clinical staff to assess benefit levels for non-medical denial determination to ensure the denial process includes letter and log maintenance. • Identifies potential stop-loss candidates to be monitored and reports to a senior-level manager. • Applies Innovista guidelines and additional approved criteria as detailed in the client UM Plan for the length of stay/admission criteria to approve initial and continued inpatient services. • Other duties as assigned.

• Performs a wide range of administrative duties to include referral processing, patient registration. • Verification of benefits and insurance authorizations. • Patient appointment scheduling and communication with referral sources. • Maintains ongoing tracking and appropriate documentation on referrals to promote team awareness and ensure patient safety. • Ensures complete and accurate registration, including patient demographic and current insurance information. • Assembles information concerning patient's clinical background and referral needs. • Provides appropriate clinical information to specialist based on referral guidelines. • Contacts review organizations and insurance companies to ensure prior approval requirements are met. • Presents necessary medical information such as history, diagnosis, and prognosis. • Provides specific medical information to financial services as appropriate to process referral. • Reviews details and expectations about the referral with patients. • Assists patients in problem solving potential issues related to the health care system, financial or social barriers. • Acts as a system navigator and point of contact for patients and individuals who have consent and direct access to patient information.

Role Description Opal Autism Centers is seeking an organized and proactive Referral Coordinator to join our growing team. In this crucial role, you will serve as the first point of contact for clients and families seeking our services. You will be responsible for coordinating referrals, managing communication between families and providers, and ensuring that potential clients receive timely and appropriate information regarding their treatment options. As a Referral Coordinator, you will play a vital role in facilitating access to quality care while providing exceptional customer service. - Manage the referral intake process, ensuring all necessary documentation is collected and entered into the system. - Communicate effectively with families and healthcare providers regarding referral status and next steps. - Schedule appointments for potential clients and follow up to confirm their attendance. - Maintain accurate and updated records of referrals and appointment outcomes. - Collaborate with clinical teams to streamline the referral process and improve client experiences. - Provide information to families about available services and assist them in navigating through the intake process. - Respond promptly to inquiries via phone, email, and in-person communication. - Assist in the development of outreach programs to increase referral sources. Working Hours This is a full-time, non-exempt position requiring availability to work 40 hours per week, typically between the hours of 8am – 6pm EST. No regularly scheduled weekend or night work required, however may occasionally be required to work on weekends or evenings. Work Environment The work environment is remote, home-based, and therefore an indoor office-like environment. Work has no exposure to environmental conditions except when required to travel for business (up to a few times annually). Qualifications - High school diploma or equivalent; additional education or experience in healthcare administration or related fields is a plus. - Proven experience in a customer service role, preferably in a healthcare or behavioral health setting. - Strong organizational skills with the ability to manage multiple tasks simultaneously. - Excellent verbal and written communication skills. - Proficient in using electronic health record (EHR) systems and Microsoft Office Suite. - Ability to work independently and as part of a team in a fast-paced environment. - Compassionate and empathetic approach to working with families and children. - Ability to maintain confidentiality and comply with HIPAA regulations. Benefits - Employee Rewards Program - earn reward points for being awesome and spend them like real cash! - Tuition discounts available - take advantage of our university partnerships with Northeastern, Capella, Ball State, Purdue Global, and more! - Access to our Student Analyst Program - offering select RBTs mentorship, opportunities to accrue supervised fieldwork hours, and clinical experience toward behavior analyst certification, based on supervisor availability (no cost or commitment). - Comprehensive benefits package, including: - Medical, dental, and vision insurance - Paid time off and 8 paid holidays + 1 floating holiday - 401(k) & other investment plan options - Drive time reimbursement (if applicable) - Referral bonuses up to $1,000 per referral - no cap! Company Description Opal Autism Centers is committed to providing equal employment opportunities to all qualified individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, genetic information, or any other protected status. We value diversity and inclusion in our workplace. By applying for this position, you acknowledge and agree to the above statement.

Healthcare is in crisis and the people behind the results deserve better. With more and more data coming from wearables, lab tests, and patient–doctor interactions, we’re entering an era where data is abundant. Junction is building the infrastructure layer for diagnostic healthcare, making patient data accessible, actionable, and automated across labs and devices. Our mission is simple but ambitious: use health data to unlock unprecedented insight into human health and disease. If you're passionate about how technology can supercharge healthcare, you’ll fit right in. Backed by Creandum, Point Nine, 20VC, YC, and leading angels, we’re working to solve one of the biggest challenges of our time: making healthcare personalized, proactive, and affordable. We’re already connecting millions and scaling fast. Refer a candidate to Junction to earn a $5,000 referral bonus!Submit your referral by clicking the 'application' tab and sharing more information with us. You can find out more details about our referral program here. A few important notes: - We only hire folks currently living in the following timezones: - EST - GMT - PHT (Philippines) - We do not offer visa sponsorship - Our referral bonus is paid out when your referral successfully passes three months of employment at Junction What is the current compensation package - Your salary is dependent on your location and experience level - Equity (extended exercise post 2 years employment) - Company and Team offsites - Monthly learning budget of $150 for personal development and productivity - 100$ Monthly wellness budget - Flexible, remote-first working - including $1K for home office equipment - Coworking budget - 36 days paid time off (including bank holidays) - Premium healthcare coverage - 4% Monthly contribution to pension/401k - Yearly blood test on us - Enhanced parental, foster and adoption leave Important details before applying: - We only hire folks physically based in GMT and EST timezones - more information here - We do not sponsor visas right now given our stage