Billing and Referral Clerk Coordinator

Job Description

Job Description

Billing and Referral CoordinatorPosition Summary

The Billing and Referral Clerk is responsible for coordinating new client referrals, supporting the prior authorization process, maintaining referral records, and completing routine Medicaid eligibility screenings. This position works closely with discharge planners, Program Administrators, Clinical Directors, and other members of the referral and billing teams.

The ideal candidate will be highly organized, detail-oriented, comfortable reviewing behavioral health documentation, and able to manage multiple deadlines across all Gardens of Arkansas locations.

Essential Duties and Responsibilities- Assist the Chief Revenue Officer with the following:Referral Intake and Coordination

· Receive and process all new client referrals.

· Review referral information and supporting documentation for completeness.

· Conduct an initial screening of referrals based on established admission criteria.

· Coordinate and schedule referral interviews.

· Communicate with discharge planners, hospital staff, social workers, Program Administrators, and other referral sources throughout the referral process.

· Follow up promptly regarding missing records, additional documentation, interview results, and admission decisions.

· Maintain professional and timely communication with referral sources and internal leadership.

· Update the referral tracking log daily.

· Prepare and distribute the referral log to the referral team weekly.

Prior Authorizations and Continued-Stay Reviews- Assist the Chief Revenue Officer with the following:

· Review behavioral health and clinical records for completeness and accuracy before submission.

· Prepare and submit documentation for all new prior authorization requests.

· Review, organize, and submit required records for quarterly authorization and continued-stay reviews for all locations.

· Track authorization dates, review deadlines, assessment dates, requests for additional information, and approval status.

· Notify Program Directors and Clinical Directors of upcoming authorization reviews, documentation deadlines, and Optum assessment dates.

· Follow up with Program Directors, Clinical Directors, and other staff to obtain missing or incomplete documentation.

· Maintain accurate records of authorization submissions, approvals, denials, expiration dates, and follow-up actions.

· Assist with correcting or resubmitting documentation when requested by Medicaid, Optum, managed-care organizations, or other payers.

Medicaid Screening

· Complete weekly Medicaid eligibility screenings for all current clients.

· Document screening results and promptly report concerns involving inactive coverage, eligibility changes, or other insurance issues.

· Work with appropriate staff to help resolve identified eligibility or coverage concerns.

· Maintain accurate and confidential documentation of all Medicaid screenings.

Documentation and Compliance

· Protect the confidentiality of all client, clinical, financial, and organizational information.

· Follow HIPAA requirements and all applicable Gardens of Arkansas policies and procedures.

· Ensure records are submitted accurately, securely, and within required deadlines.

· Assist with audits, record requests, billing reviews, and compliance-related documentation as needed.

· Maintain organized electronic and paper records in accordance with company requirements.

Required Qualifications

· High school diploma or equivalent required.

· Experience reviewing behavioral health, mental health, medical, or clinical records required.

· Strong computer literacy and the ability to learn electronic health record, billing, authorization, and tracking systems.

· Proficiency with email, Microsoft Office, spreadsheets, electronic documents, and online portals.

· Strong organizational and time-management skills.

· Excellent attention to detail and accuracy.

· Ability to manage multiple deadlines and follow-up responsibilities.

· Strong written and verbal communication skills.

· Ability to communicate professionally with hospitals, discharge planners, social workers, clinical professionals, administrators, and insurance representatives.

· Ability to work independently while also collaborating with multiple departments and locations.

· Ability to handle confidential and sensitive information appropriately.

Preferred Qualifications

· Previous experience with behavioral health billing, Medicaid, prior authorizations, utilization review, referral coordination, or insurance verification.

· Familiarity with Optum assessments or managed-care authorization processes.

· Experience working in a behavioral health, residential treatment, community support, healthcare, or disability-services setting.

· Experience using electronic health record systems and Medicaid eligibility portals.

Knowledge, Skills, and Abilities

· Ability to review records and identify missing, inconsistent, or incomplete information.

· Ability to understand and follow payer documentation requirements.

· Ability to prioritize urgent referrals and time-sensitive authorization deadlines.

· Ability to maintain accurate tracking logs and reports.

· Ability to work professionally with internal and external stakeholders.

· Dependability, initiative, and strong follow-through.

· Commitment to accuracy, confidentiality, accountability, and excellent service.

Additional Responsibilities

· Participate in meetings, training, and process-improvement activities as required.

· Provide administrative support to the referral, clinical, billing, and leadership teams as needed.

· Perform other duties as assigned.

Physical and Work Requirements

· Prolonged periods of sitting and working at a computer.

· Ability to communicate by telephone, email, video conferencing, and in person.

· Ability to organize, review, scan, upload, and maintain electronic and paper records.

· Ability to work in a fast-paced environment with frequent deadlines and interruptions.

Equal Employment Opportunity

The Gardens of Arkansas is an equal opportunity employer. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other characteristic protected by applicable law.