Job Description

Job Description

Responsibilities

Responsible for scheduling referrals for patients, providers, pre-authorizing & pre-certing tests/procedures. Scheduling of other tests with facilities at the request of providers and/or staff. Directly communicates with the clinics, referred to clinics, and patients. Reviews clinical data to report medical necessity to insurance companies. Performs all work with accord to the mission, vision and values of the practice.

Qualifications

Education: High school graduate or GED required.

Work experience: Minimum of two years' experience in a healthcare or clinical setting.

Knowledge:

* Knowledge of clinical terminology, insurance billing, procedural and diagnosis coding, federal and state insurance

regulations and HIPAA privacy standards is strongly preferred.

* Typing, 10 key and computer skills required.
* Proficiency in Microsoft Office applications required.
* Required effective interpersonal skills and excellent written, oral communication skills required.
* Acute healthcare knowledge and ability to evaluate clinical data to acquire pre-authorizations and referrals is preferred. Knowledge of third party reimbursement regulations is preferred.
* Patient Management, Billing and Managed Care system processes competency. Understanding of functions and work flow of Clinical/Hospital departments.
* Excellent planning and organizational skills. Demonstration of strong analytical skills and problem-solving abilities. Strong teamwork skills and the ability to effectively communicate with all management levels.
* Results oriented, independently goal directed, able to multi-task and meet established time frames.
* Excellent customer service skills and must be able to work independently.

Essential Job Duties

1.

Communicates effectively with clinics and hospital.

2

Communicates effectively with patients.

3.

Communicates information to appropriate areas, departments and individuals.

4.

Addresses patients in a polite, prompt and helpful manner

5.

Answers the phone within four (4) rings in a courteous manner identifying self and department.

6.

Maintains a clean and orderly office and waiting area.

7.

Orders supplies for the office within budgetary guidelines.

8.

Returns all emails within 48 hours

9.

Covers at other clinics as a receptionist as requested

10.

Schedules tests and referral appointments within 24 hours from receiving the physician order.

11.

Notifies patients within 24 hours of their appointment.

12.

Maintains a daily referral log.

13.

Pre-certify appropriate tests with insurance companies within 48 hours of physician order.

14.

Communicate pre-certification results to the patient and/or office in a timely matter.

15.

Demonstrates knowledge and skills to operate EMR software efficiently and effectively.

16.

Demonstrates knowledge of computer downtime procedures.