Under the direction of the Director, Outpatient Clinics provides administrative support to the outpatient specialty clinics. Verifies insurance eligibility, benefits, referral and authorization requirements for the Clinics. Ensures all exams requiring a Prior Authorization and/or Referral are coordinated through the appropriate insurance provider or intermediary, and documents in electronic medical record. Requires knowledge of CPT codes and ICD-10 codes. Provides administrative support for physicians by answering and screening telephone calls, and taking accurate messages. Schedules patient surgeries, coordinating and communicating with other hospital staff as needed. Types correspondence, manuscripts and documents that may require complex formatting. Checks in patients in CCC as needed. Schedules office appointments and imaging exams as necessary. Manages physician billing as needed.The highest regard for patient confidentiality is an expectation at all times. Acts in a professional manner and puts patient needs first.
Secures all required prior authorizations and documents in OMR. Makes follow up calls to prior authorization agents as needed to ensure timely turnaround of prior authorization documentation. Completes forms including disability, back to work and FMLA for patients.
Responsible for interviewing patients or their representative, obtaining personal information or verifying information already on file, including emergency numbers, next of kin, employer and insurance information.
Secures all referrals for outpatient clinic visits and documents in OMR, may include medical clearance, physical therapy, etc.
Prepare all medical records, as requested from attorneys and set up all peer to peer reviews for Physicians, as needed.
Secures approval for surgery and ensures medical clearance prior to surgery. Schedules patient surgeries, including worker's compensation surgeries, coordinating and communicating with other hospital staff as needed.
Required Qualifications:High School diploma or GED required.
0-1 years related work experience required.
Ability to work independently with minimal supervision.
Exhibits excellent customer service.
Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.
Preferred Qualifications:Minimum of 3 years to 5 years in a hospital financial setting, or clinical setting.
Understanding of hospital collections a plus.
Competencies:Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.
Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.
Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.
Oral Communications: Ability to comprehend and converse in English to communicate effectively with medical center staff, patients, families and external customers.
Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
Team Work: Ability to work collaboratively in small teams to improve the operations of immediate work group by offering ideas, identifying issues, and respecting team members.
Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.
Age based Competencies:
Employees in this job must be competent to provide patient care to the following age groups: Neonatal:Birth to 6 months, Youth: 6 months to 16 years, Young adult: 16-30 years, Middle Age: 30 - 60 years, Elderly: 60 -.
Physical Nature of the Job:
Light work: Exerting up to 20 pounds of force frequently to move objects. Some elements of the job are sedentary, but the employee will be required to stand for periods of time or move through out the hospital campus