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Authorization and Referral Clerk

Category:

Admitting

Department:

Admitting & Registration

Status:

PRN

Description:

Minimum Entry Level Qualifications

  1. Experience and/or level of competency: High School graduate or equivalent.
  2. 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

Job Summary:

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.

Specific Responsibilities:

  1. Call Insurance companies to obtain authorizations for all types of visits.
  2. Obtain retro referrals for afterhours clinic and assist with distribution of medical records.
  3. Assist in the credentialing of providers to ensure prompt payment for procedures or clinic visits.
  4. Creates and approves payment arrangements; reviews with patient/family different payment options and possible financial assistance, i.e., state and local agencies, indigent care.
  5. Reviews all patient self-pay accounts. Meets with patient/family to obtain a satisfactory payment agreement for all parties.
  6. Reviews patient charges; evaluates patient's assets and liabilities to determine patient payment schedules.
  7. Ensures patient demographic and insurance information is correct in the computer system.
  8. Documents all payment agreements in the computer database; sends payment confirmation letter to patient/family.
  9. Documents all patient contact in the computer system.
  10. Assists patients with Medicaid and SSI applications and refers patients to other Social Services as applicable.
  11. Reviews Medicaid denials and assists patients/families with appeals if appropriate.
  12. Communicates with financial agencies, assisting patients, regarding patient eligibility and/or financial settlement.
  13. Prepares patient itemized bill upon request; explains charges, payments and adjustments.
  14. Monitors patient accounts; initiates collection procedures when appropriate.
  15. Performs other duties as assigned.