Clinic Operations Representative - Primary Care TheARC

Minimum Education
High School Diploma or GED (Required)

Minimum Work Experience
1 year Experience performing billing, patient registration, and 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

• Demonstrate 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.

• Reschedule appointment for patients who did not show or for the ancillary services cancellations by providers/technologist. Schedule follow up appointments at check out if applicable.

• 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.

• 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.

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

Cash Collection

• 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.

• Maintain departmental requirements regarding cash controls and collections.

Billing Preparation

• 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.

• Appropriately clear all walk-in and ensure scheduled/unscheduled appointments are linked to scheduling system.

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 PAR levels.

• Maintain clean reception area and workspace.

• Other support as needed.

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

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