Authorization and Referral Clerk

Val Verde Regional Medical Center • Del Rio, TX

426d

About The Position

The Authorization and Referral Clerk plays a crucial role in the Admitting Department by coordinating with clinical staff, providers, and billing vendors to secure insurance authorizations for patients prior to their visits or procedures. This position is essential for ensuring that all necessary authorizations are obtained for various types of medical services, including office visits, surgeries, and outpatient procedures, thereby facilitating smooth operations within a multi-specialty clinic.

Requirements

• Active LVN license in the State of Texas.
• High School graduate or equivalent.
• Minimum of two (2) years' experience in medical billing, collections, insurance, and coding required.
• Ability to effectively communicate in English, both verbally and in writing.
• Excellent interpersonal skills.
• Basic computer knowledge.
• Excellent customer service skills.

Nice To Haves

• Additional languages preferred, especially Spanish.

Responsibilities

• Call insurance companies to obtain authorizations for all types of visits.
• Obtain retro referrals for after-hours clinic and assist with distribution of medical records.
• Assist in the credentialing of providers to ensure prompt payment for procedures or clinic visits.
• Create and approve payment arrangements; review with patient/family different payment options and possible financial assistance.
• Review all patient self-pay accounts and meet with patient/family to obtain a satisfactory payment agreement.
• Review patient charges; evaluate patient's assets and liabilities to determine payment schedules.
• Ensure patient demographic and insurance information is correct in the computer system.
• Document all payment agreements in the computer database and send payment confirmation letters to patients/families.
• Document all patient contact in the computer system.
• Assist patients with Medicaid and SSI applications and refer patients to other Social Services as applicable.
• Review Medicaid denials and assist patients/families with appeals if appropriate.
• Communicate with financial agencies regarding patient eligibility and/or financial settlement.
• Prepare patient itemized bills upon request and explain charges, payments, and adjustments.
• Monitor patient accounts and initiate collection procedures when appropriate.
• Perform other duties as assigned.

What This Job Offers

• Job Type: Full-time
• Industry: Hospitals
• Education Level: High school or GED