Senior Clinic Operations Representative - Washington, United States - CNHS

CNHS Washington, United States

3 weeks ago

Full time

Description

:

This role reports to either the Clinic Operations Supervisor or the Practice Manager.

Its primary responsibilities include overseeing clinic workflow, initiating and completing authorizations for the Neuroscience department, and assisting with front-end operations during staffing shortages.

Additionally, the role involves addressing resource issues within the clinic, seeking support from supervisors or managers as necessary, and contributing to the department's financial objectives.

Providing training and mentorship to colleagues within the department and other departments is also expected.

The role requires proficiency in all functions of a COR (Clinical Operations Representative) and may involve floating to other clinics or ROCS (Regional Outpatient Centers) for coverage.

It is specifically tailored to support single-specialty ambulatory clinics, with the next career advancement typically being a Team Lead position.

Qualifications:

Minimum Education
High School Diploma or GED (Required)
Associate's Degree (Preferred)

Minimum Work Experience
3 years Experience performing billing, patient registration, scheduling, medical insurance verification, insurance screening. (Required)

Required Skills/Knowledge
Broad clinic knowledge, customer service skills. Computer knowledge necessary. Microsoft Office experience preferred (Word & Excel). Complete Ambulatory Services training curriculum and pass all competency assessments, including a mock clinic. The ability to type minimum of 35 words per minute required.

Functional Accountabilities
Patient Services
Ensure accuracy of scheduling patients using the applicable scheduling system for the department.
Complete computer aided, on-line registration screen with parent/guardian via telephone or in person in professional & courteous manner.
Collect accurate demographic and insurance information. Update systems as needed in accordance with department standards for registration accuracy .
Updates scheduling systems with cancellation and no shows by COB. Reschedule appointment for patients who did not show or for clinic cancellations by providers. Schedule follow up appointments at check out if applicable. Able to open and close schedules as needed.
Greet patients and parents courteously. Arrive patient in appropriate system based on department policy .
Obtain required consents for department & ensure distribution of compliance related materials (i.e. HIPPA Privacy Notice, Patient Rights). Obtain copy of insurance card and photo ID to be stored in medical record (copy or scan activity required). Ensure applicable insurance company and CNMC HIM department receive copies of appropriate forms/documentation. Complete all documentation in accordance with department policy and procedure.
Collect and record co-payments, deposits and payments in full and provide payer with receipt:

Responsible for helping department meet 85% of the collection target for the department.
Respond to patient portal work lists (i.e. appointment requests, fax queues, email requests, etc. May include messaging center work lists in the future).
Information Verification
Verify insurance eligibility using applicable eligibility system. Ensure managed care carve outs (lab and radiology carve outs) are adhered to.
Notify parents of the need for completed insurance referral form or pre-authorization prior to scheduled/unscheduled appointments.

Discuss co-payment, deposits, payment in full, or past due balance collections with parents prior to scheduled appointment in a professional & courteous manner.

Counsel parents or refer parent to Financial Information Center (FIC) for establishing payment schedule or method of payment.
Verify insurance information is complete prior to procedure and collect and verify pre-authorization/referral information:

Goal is to obtain authorizations 5 days in advance of service; Interface with insurance companies as needed; Document activity in "account notes" following standards set by department.

Utilize all systems where patient information may be stored (EPRS, SCI, Cerner, IDX, McKesson, etc.) to verify that systems are in synch.

Billing Preparation & Daily Reconciliation
Reconcile schedules for upcoming clinic session to include ensuring that accounts are set up for billing and services requiring authorization are flagged:

Activity should be completed 3-4 days in advance of clinic session; Areas with procedures requiring authorizations work standard may be 5-7 days.

Review and print clinic schedules, ensure appropriateness of scheduled appointments and back fill open slots:

Activity should be completed 3-4 days in advance of clinic session; Areas with procedures requiring authorizations work standard may be 5-7 days.

Verify that families received automated appointment reminder calls and ensures manual confirmations are completed for those that failed the automated messaging:

Activity should be completed 3-4 days in advance of clinic session; Areas with procedures requiring authorizations work standard may be 5-7 days.

Maintain departmental requirements regarding cash controls and deposits. Reconcile daily cash receipts/collections and submit to manager.
Reconcile charge capture against schedules.
Ensures that quality registration work queues are addressed timely:

Activity should be completed 3-4 days in advance of ancillary session; Work standard may be 5-7 days for areas with procedures requiring authorizations.

Performance Improvement, Mentoring and Training
Work with manager to reduce registration and authorization denials.
Work with manager to research and resolve missing charges.
Provide input to manager about registration errors for ongoing training purposes:

Monitor & correct registration errors; Monitor QA reports to identify training needs & ensure standards are met.
Provide expertise to peers throughout the institution:

Train & mentor P AR staff (may conduct training sessions); Provide work flow guidance.
Office Support
Answer telephone and address caller needs appropriately. Avoid transferring calls for better service to families. Meet department standards relative to ACD policies if applicable. Manage voice mail messages within same business day .
Distribute mail. May work returned mail as needed.
All staff are responsible for information distributed via e-mail.

Staff should check work email a minimum of 3 times daily and respond to inquiries within 24 hours (or next business day).

Maintain office files and office supplies at P AR levels.
Maintain clean reception area and work space.
Other support as needed.

Organizational Accountabilities
Organizational Accountabilities (Staff)
Organizational Commitment/Identification

Anticipate and responds to customer needs; follows up until needs are met

Teamwork/Communication

Demonstrate collaborative and respectful behavior
Partner with all team members to achieve goals
Receptive to others' ideas and opinions

Performance Improvement/Problem-solving

Contribute to a positive work environment
Demonstrate flexibility and willingness to change
Identify opportunities to improve clinical and administrative processes
Make appropriate decisions, using sound judgment

Cost Management/Financial Responsibility

Use resources efficiently
Search for less costly ways of doing things

Safety

Speak up when team members appear to exhibit unsafe behavior or performance
Continuously validate and verify information needed for decision making or documentation
Stop in the face of uncertainty and takes time to resolve the situation
Demonstrate accurate, clear and timely verbal and written communication
Actively promote safety for patients, families, visitors and co-workers
Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance

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