Referral Specialist

Paycom - ATS; Waco (TX); On-site; USD 36,000 - 48,000; Full time

Job summary

Family Health Center is seeking a detail-oriented referrals and billing clerk to support clinical referrals, authorization coordination, and patient scheduling. The role requires handling insurance verifications, maintaining accurate referral notes, and ensuring timely processing in a fast-paced environment.

Qualifications include a high school diploma, basic billing knowledge, and strong communication skills.

Qualifications

• High school diploma or equivalent required.
• College hours and/or referral/authorization experience preferred.
• Bilingual in Spanish and English helpful.
• Must have strong computer literacy and knowledge of ICD-10/CPT coding.

Responsibilities

• Initiates and manages all components of clinical referrals for various services.
• Coordinates flow of information between clinic and referral authorization department to secure valid referrals timely.
• Schedules and notifies patients of all applicable appointments.
• Verifies insurance coverage and obtains authorizations, if needed.
• Notifies registration staff to update insurance coverage as needed.
• Maintains proper documentation and management of pre-authorization/referral information.
• Documents clear information in Referral Notes with correct spelling and grammar.
• Learns and implements all policies and protocols as directed.

Skills

Computer literacy

Excel

Medical Terminology

ICD-10/CPT coding

Medical office billing and collection

Financial assistance programs

Interpersonal communication

Telephone skills

Education

High school diploma or equivalent

College hours and/or referral/authorization experience

Bilingual in Spanish and English

Job description

PRIMARY DUTIES:Initiates and manages all components of clinical referrals for various servicesCoordinates flow of information between medical clinic and referral authorization department to secure valid referrals timely for clinic patientSchedules and notifies patients of all applicable appointmentsVerifies insurance coverage and obtains authorizations, if needed, from insurance plansNotifies registration staff to update insurance coverage as neededMaintains proper documentation and management of the pre-authorization/referral information (faxing, scanning, etc.)Documents clear information in Referral Notes on any transactions pertaining to referral or authorization processes using correct spelling and grammar skillsLearns and implements all policies and protocols as directedKeeps informed of changes and updates for insurance plan policies for Authorizations and ReferralsComplies with all regulations related to patient confidentialityAble to manage multiple priorities and manage stress appropriatelyCommunicates appropriately and clearly with a pleasant and professional manner to allDemonstrates excellent judgment in handling situations not covered by written or verbal instructionsDemonstrates a commitment to the mission, core values, and goals of Family Health Center and its healthcare delivery including the ability to deliver exceptional patient focus with quality, compassion and respectOTHER DUTIES:Cover duties of co-workers as neededOther duties as assignedPHYSICAL AND MENTAL REQUIREMENTS:Visual and auditory accuracyShift length – 8 hoursIndoor settingContinuous use of computer and calculatorLong periods of sittingFrequent use of telephoneContinuous repetitive grasping and manipulation of both handsContinuous conversational communicationOccasional lifting and carrying of up to 10 lbs.Occasional standing, reaching, walking, bending, and twistingInfrequent use of personal transportationOccasionally working in noisy, confined areasUnderstand/carry out simple/detailed, oral/written instructionsMemorize and retain instructionsRead and interpret detailed specificationsEDUCATION: High school diploma or equivalent required, College Hours and/or Referral/Authorization Experience preferred, Bilingual in Spanish and English helpfulREPORTS TO: Director of Billing ServicesSKILLS: Computer literacy, Excel, Medical Terminology, Knowledge of ICD-10/CPT coding, Medical office billing and collection practices, Federal/state/local financial assistance programs, Strong interpersonal, oral and written communication, Excellent telephone skills and strong customer service focus