Clinic Operations Rep

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.
• 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.).

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.
• 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.
• 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 work space.
• 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.