Obtains all prior authorizations for services that are not customary plan benefits. This includes calling on referrals and scheduling and interaction with Primary Care Physicians and/or Referring Physicians.
Competencies -To perform the job successfully, an individual should demonstrate the following competencies:
Design - Demonstrates attention to detail.
Problem Solving - Identifies and resolves problems in a timely manner; Works well in group problem solving situations; Uses reason even when dealing with emotional topics.
Technical Skills - Assesses own strengths and weaknesses; Pursues training and development opportunities; Strives to continuously build knowledge and skills; Shares expertise with others.
Customer Service - Manages difficult or emotional patient situations; Responds promptly to Patient needs; Solicits Patient feedback to improve service; Responds to requests for service and assistance; Meets commitments.
Interpersonal Skills - Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things.
Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Participates in meetings.
Written Communication - Writes clearly and informatively; Able to read and interpret written information.
Teamwork - Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed.
Visionary Leadership - Inspires respect and trust.
Quality Management - Looks for ways to improve and promote quality; Demonstrates accuracy and thoroughness.
Ethics - Treats people with respect; Keeps commitments; inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
Organizational Support - Follows policies and procedures; Completes administrative tasks correctly and on time; supports organization's goals and values.
Judgment - Makes timely decisions.
Motivation - Sets and achieves challenging goals; Demonstrates persistence and overcomes obstacles; Measures self against standard of excellence.
Planning/Organizing - Prioritizes and plans work activities; Uses time efficiently; Sets goals and objectives.
Professionalism - Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments.
Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Monitors own work to ensure quality.
Quantity - Completes work in timely manner.
Safety and Security - Observes safety and security procedures; Reports potentially unsafe conditions; Uses equipment and materials properly.
Adaptability - Adapts to changes in the work environment; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
Attendance/Punctuality - Is consistently at work and on time; Arrives at meetings and appointments on time.
Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Completes tasks on time or notifies appropriate person with an alternate plan.
Initiative - Volunteers readily; Undertakes self-development activities; Looks for and takes advantage of opportunities; Asks for and offers help when needed.
Innovation - Meets challenges with resourcefulness; Generates suggestions for improving work.
Education and/or Experience
High School diploma or general equivalency diploma (GED).
Background in insurance authorization and scheduling.
Extensive customer service experience.
Minimum two years of experience in a medical office setting.
Essential Duties and Responsibilities include the following:
Obtains prior authorizations and referrals.
Inputs correct data into Intergy.
Performs clerical duties related to clinical service.
Prepares and processes correspondence.
Answers telephone, takes messages, and provides information.
Requests, locates, sends and receives patient records.
Monitors internal communications including but not limited to task, emails, and voice mails.
Maintains files and assists establishing office systems.
Assists in the care and maintenance of office equipment.
Fulfills clerical responsibilities as assigned that may include sending/receiving patient medical records; obtaining lab/x-ray reports, hospital notes, referral information, etc.; scheduling appointments; verifying insurance coverage; managing and updating EMR charts to ensure that information is complete and filed appropriately;
Fulfills the organizations responsibilities as assigned including; respecting and promoting patient’s rights; sharing problems with immediate supervisor.
Other duties as assigned
Manual dexterity for office machine operation including computer and calculator; stooping, bending to handle files and supplies, sitting for extended periods of time. The employee must regularly lift and/or move up to 10 pounds, frequently life and/or move up to 25 pounds and occasionally life and/or move up to 50 pounds. Stress can be triggered by multiple staff demands and deadlines.
Work is performed in an office environment. Involves frequent contact with staff.