Authorization and Referral Clerk

Summary of Essential Duties and Responsibilities:

The Referral and Authorization Clerk is responsible for coordinating patient referrals, processing authorizations, and ensuring that all necessary documentation is completed accurately and submitted in a timely manner. This role is essential in keeping patients informed about the status of their referral and authorization, ensuring transparency by providing updates, clarifying any issues, and acting as a liaison between patients, providers, and insurance companies.

Specific duties and responsibilities include:

· Process and manage referrals from primary care providers and specialists. Confirm patient eligibility, verify insurance coverage, and document all referral information in the patient’s medical record.

· Obtain pre-authorizations for services required by insurance providers. Ensure that all required paperwork, supporting documentation, and medical necessity information is submitted accurately to facilitate authorization.

· Act as a liaison between providers, insurance companies, and patients. Keep all parties informed of the referral and authorization status, answer questions, and provide updates as necessary.

· Review and verify patient’s insurance information before submitting referrals and authorization requests. Confirm coverage, co-payments, and other relevant details.

· Accurately input and maintain referral and authorization information in the ARM (Authorization Referral Management) system, ensuring compliance with privacy and confidentiality regulations, such as HIPAA.

· Address issues or delays related to authorization denials or incomplete referrals by coordinating with healthcare providers, payers, and patients to facilitate resolution.

· Track and follow up on all pending referrals and authorizations. Ensure that patients are aware of any required additional steps and that authorizations are approved before services are rendered.

· Maintain a professional office environment on a day-to-day basis, working with confidential and personal health information in a conscientious manner and providing patients and other requestors with the appropriate level of service.

· Participate in educational programs to stay abreast with developments in the customer service industry to expand job knowledge and customer support.

· Studies and standardizes processes and procedures for accuracy, efficiency, and effectiveness.

· Works well in a team effort

· Excellent oral and written communication skills. Maintains tactful and effective communication.

· Other duties as assigned.

Supervisory Responsibilities: This position has no supervisory duties.

Qualifications: Ability to perform each essential job duty satisfactorily. Strong interpersonal, technical and communication skills. Sound analytical and organization skills. Self-motivated and self-directed. Ability to work closely with clinical and business office teams in a collaborative, interactive team environment.

Education and/or Experience: High school diploma or general education degree (GED) required. Strong computer skills. At least two (2) years of financial experience and background strongly encouraged and preferred. Understanding of medical/clinical treatment processes. Knowledge of major third-party payors and contracts. Working knowledge of Microsoft Word, Excel, and Internet-access engines.

Customer Service: Supports and upholds the Organization’s philosophy of customer service. Assists with the identification of educational needs for the staff. Takes an active role in customer service issues as necessary. Recommends organizational and departmental improvements based on appropriate customer concerns. Treats all people with dignity and respect. Demonstrates a willingness to look beyond the defined scope of the job to take care of patients. Exhibits a positive attitude and a positive view of the organization. Consistently uses diplomacy and respect both in person and on the telephone and performs effectively and professionally under stressful conditions.

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Education:

• High school or equivalent (Required)

Ability to Relocate:

• Spencer, WV 25276: Relocate before starting work (Required)

Work Location: In person