Responsibilities

Position Summary: The Patient Services Specialist will perform administrative duties as it relates to clinical needs of patient care and the nursing staff. Performs a variety of tasks related to patient needs and any relevant paperwork required to be completed in a timely manner (daily basis). The Patient Services Specialist is responsible for obtaining authorizations for surgeries and procedures, referrals, scheduling surgeries, and completing paperwork related to disability, medical record requests, and workers compensation. Meet with patient or contact patient to confirm appointments and enter test results in EMR. Coordinate with clinical staff to inform patient of test results.

PRIMARY DUTIES:

Schedule outpatient and/or inpatient diagnostic and/or screening testing (Imaging, Procedures, Labs, etc.) with patient at point of care - Review orders and referrals from EMR, schedule diagnostic or screening testing following appropriate protocols, communicate appointment with patient and provide guidance on preparation.

Schedule outgoing referral appointments at point of care – Schedule all referral appointments based on referral orders entered by the provider. Discuss pertinent referral appointment information with the patient at the point of care. Coordinate with referral sources to close the referral loop.

Initiate and verify completion of prior authorizations – Initiate prior authorizations when appropriate, assist in verifying medical necessity and work with the clinical team to amend orders when necessary.

Perform first contact resolution on all incoming phone calls – Address all incoming phone calls with first contact resolution, relaying appropriate information to patient regarding normal results (following set practice guidelines), prescriptions, scheduling, problem resolution and service recovery. Document all communication in the EMR and forward telephone encounters to appropriate individuals if first call resolution is not achieved.

Process fax inbox and complete medical records management – Review incoming faxes and place in medical record as appropriate. Attach referral notes, lab/imaging results, procedure notes and all other incoming documentation to the appropriate orders. Process medical records requests including transfer of records, receipt of new patient historical records, legal requests (subpoena), etc. Ensure chain of custody and HIPAA requirements met for all transactions.

Ensure diagnostic testing and referral loops are closed - Maintain tickler files to track patient results, coordinate with testing department to obtain results in timely manner, ensure test results are placed in EMR and inform providers if patient does not complete testing. Coordinate with incoming and outgoing referral sources to close the referral loop on all referrals.

Facilitate referrals to community resources - Meet with patients who require financial assistance for care and complete referral application for financial assistance and initiate communication with TCCN to facilitate processing and approval application. Coordinate other community resource needs with care coordinators, i.e. transportation, family services, special needs support, etc.

Assist with patient portal enrollment and utilization of kiosk - Provide personal assistance to patients who express interest in enrolling in the patient portal or utilizing the registration kiosk. Coordinate technical issues with IT support team.

Transitional Care Management (TCM) Coordination - For selected patient populations, review hospital discharge notes and perform initial phone contact with patients in compliance with TCM billing requirements.Utilize clinical protocols to determine timeframe for TCM appointment.

Other duties as assigned - Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee partner for this job. Duties, responsibilities and activities may change at any time with or without notice.

QUALIFICATIONS

Education:

• Must meet one of the following:
• Associates Degree in Business or Healthcare related field and a minimum of three (3) years healthcare or comparable experience OR;
• Certified Medical Assistant with experience in scheduling, prior authorizations and referral processing OR;
• High School Diploma with a minimum of five (5) years healthcare or comparable experience.

Experience:

• Demonstrated experience with strong interpersonal communication skills, required.
• Prior experience with interpreting and following detailed policies and workflows, required.
• Competency with Microsoft Office applications, required.
• Prior experience with Electronic Medical Record in physician office environment, required.
• Ability to complete Disability, Medical Records, Workers Compensation, and FMLA paperwork requested by patients, required.
• Prior experience obtaining authorizations and scheduling procedures, images, and surgeries, preferred.
• Prior experience with Meditech and E-Clinical Works software program, preferred.
• Prior experience scheduling patients, preferred.

Skills:

• Medical Terminology knowledge, required.
• Demonstrated ability to independently think and make judgments in interpreting and adapting guidelines and making judgment decisions on specific problems, required.
• Demonstrated ability to handle multiple projects and tasks efficiently (time management), required.

Other:

• Day shift M-F position
• Exposure to diseases possible but not probable due to controlled environment and limited exposure to patients

Physical Requirements: Light Physical Agility Test (PAT) Rating

While performing the duties of this job, the employee is frequently (activity or condition exists from 1/3 to 2/3 of the time) required to stand, sit, and walk; frequently to use hands, fingers; and frequently to talk or hear. The employee must exert up to 15 pounds of force occasionally (activity or condition exists up to 1/3 of the time), and/or up to 5 pounds of force frequently, and/or a negligible amount of force constantly to move objects.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.