Medical Referrals/Authorization Clerk
West Ventura Medical Clinic - Ventura, CA

Job Purpose: Under the supervision of the Referral Supervisor and/or the general direction of the Clinic Manager, the Authorization and Referral Clerk facilitates requests for authorization & referrals under a provider’s order.

Duties may include, but are not limited to the following:

• Receive requests from referring physicians via the electronic medical record, telephone or fax and strive to complete urgent referrals within two business days and routine referrals within one business week.
• Refer cases to initial clinical review when appropriate.
• Request prior authorization from insurance companies; schedule diagnostic procedures and appointments as appropriate.
• Provide information to referring physicians’ offices regarding covered benefits.
• Notify patients of covered benefits & schedule appointments.
• Receive verification requests from rendering providers; verify registration information and log verification into database.
• Receive and handle general information requests via telephone and facsimile from various external sources.
• Initiates, maintains & updates tracking systems for incoming & outgoing referrals.
• Responsible to track each case from initial referral all the way through the service being provided and the requesting provider receiving the documentation on the services performed or the patient refusing to follow through with the referral. Document each development timely, consistently and accurately in the electronic medical record.
• Participate in utilization management and quality management programs as directed.
• Comply and keep current with accreditation standards and federal, state and local regulatory requirements.
• Perform other assignments as directed.

Skills/Qualifications:

• Excellent verbal, written communication and interpersonal skills to enhance interactions with staff, patients, patient’s families, physicians, and other health care organizations.
• Proven track record in effective customer service.
• Advanced organization, time and stress management skills to handle a multitude of tasks efficiently, on time with excellent results.
• Knowledge of medical terminology (CPT & ICD-10 codes) preferred.
• Experience with reimbursement instruments, standard claim/medical forms.
• Bilingual, English/Spanish required.

Education/Experience:

• High school diploma or equivalent. Medical Assistant or Billing Certificate, some college preferred.
• Two years of Authorizations/Referrals experience strongly preferred.
• Experience with electronic medical records and standard PC Software applications required.
• Experience in healthcare setting (Hospital, physician’s office, health plan) required.
• Claims handling or customer service experience in a multi-function call center preferred.

Job Type:
Full-time

Required Education:
High school or equivalent

​Required Experience:
Referrals: 1 year
​
Required Language:
Spanish

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