Authorization and Referral Clerk
Admitting & Registration
Minimum Entry Level Qualifications
- Experience and/or level of competency: High School graduate or equivalent.
- Academic Preparation: Minimum of two (2) years’ experience in medical billing, collections, insurance, coding required. LVN Preferred; Will substitute experience if necessary. Ability to effectively communicate in English, both verbally and in writing. Excellent interpersonal skills. Additional languages preferred. Spanish. Basic computer knowledge. Excellent customer service
Through a coordinated effort with the Admitting Department, Clinical Staff and Providers and Billing Vendor, this position assists in the screening of private or self-pay patients to secure authorization of insurance prior to the time of visit and or procedure. This includes office visits, office procedures, in-patient and outpatient procedures both scheduled and un-scheduled; to include surgeries, radiology or any other type of procedure or visit that an authorization could be deemed necessary. Authorizations are obtained for a multi-specialty clinic, vast medical history and ability to learn new disciplines is desired.
- Call Insurance companies to obtain authorizations for all types of visits.
- Obtain retro referrals for afterhours clinic and assist with distribution of medical records.
- Assist in the credentialing of providers to ensure prompt payment for procedures or clinic visits.
- Creates and approves payment arrangements; reviews with patient/family different payment options and possible financial assistance, i.e., state and local agencies, indigent care.
- Reviews all patient self-pay accounts. Meets with patient/family to obtain a satisfactory payment agreement for all parties.
- Reviews patient charges; evaluates patient's assets and liabilities to determine patient payment schedules.
- Ensures patient demographic and insurance information is correct in the computer system.
- Documents all payment agreements in the computer database; sends payment confirmation letter to patient/family.
- Documents all patient contact in the computer system.
- Assists patients with Medicaid and SSI applications and refers patients to other Social Services as applicable.
- Reviews Medicaid denials and assists patients/families with appeals if appropriate.
- Communicates with financial agencies, assisting patients, regarding patient eligibility and/or financial settlement.
- Prepares patient itemized bill upon request; explains charges, payments and adjustments.
- Monitors patient accounts; initiates collection procedures when appropriate.
- Performs other duties as assigned.