Clinical Administrative Support II

Job Description Summary

As an Ambulatory Access Coordinator II – Referrals, you will be responsible for a wide variety of tasks associated with patient care referrals; ensure the timely processing of insurance authorizations; work in collaboration with clinical staff and other departments to maximize efficiency; assist patient with referral-related questions and issues.

Job Description

ESSENTIAL FUNCTIONS

1. Log onto phone system at scheduled time and answers all incoming calls in a prompt, courteous and helpful manner, routing them to the appropriate extension and responding to requests for information.

2. Processes test/procedure referral requests for all patients:
• Reviews each referral to determine special services/procedures being requested.
• Informs the patient of providers/facilities used by SSMC and provides contact information so the patient may schedule the appointment.
• Updates the patient’s referral within the EMR to reflect status changes and document additional information as needed.
• Obtains insurance-specific authorization and communicates to patients and/or facilities with insurance issues.
• Provides referring facility with clinical information needed to support medical necessity or continuation of care.
• Processes Worker’s Compensation prior authorizations for diagnostic imaging and procedures, as needed.
• Communicates requests from patients who wish to seek care outside SSMCs preferred providers.
• Requests ‘reconsiderations (peer-to-peer)’ discussion from provider for insurance denials via referral message.
• Communicates issues to PCP/ Triage via Telephone Encounters.
• Processes faxed prior authorization / denial requests.
• Monitor EPIC messages including, but not limited to, MyChart messages for prior authorization requests by securing referral authorizations and posted to internal order and faxing outside order to facility.

3. Works independently to complete daily assignments by the end of the shift and long term assignments by established deadline.
• Efficiently manages work schedule to accomplish assignments and activities before deadline.
• Works independently with infrequent need for supervision.
• Informs supervisor when not able to meet deadline.

4. Embraces technological solutions to work processes and practices.
• Accepts changing environment as technology advances, willing to learn new techniques and equipment.
• Receptive to changes in department work processes and practices.
• Seeks appropriate guidance for new techniques.
• Offers suggestions for change to improve department.
• Participates in continued learning and possess a willingness and ability to learn and utilize new technology and procedures that continue to develop in their role and throughout the organization.
• Embraces technological advances that allow us to communicate information effectively and efficiently based on role.

5. Staff will work to enhance the patient experience in every interaction.
• Demonstrates professional courtesy in all interactions with patients and coworkers.
• Answers all questions in a polite, professional manner or finds someone who can answer the question.
• Able to handle difficult patients or situations in a calm, professional manner.
• Able to report issues/concerns using the chain of command.

6. Staff is able to independently manage daily office functions:
• Able to perform multiple work tasks efficiently and effectively.
• Able to maintain a high level of concentration at all times.
• Able to work under pressure and to maintain composure during stressful situations.
• Able to complete tasks according to assigned deadlines.
• Utilizes critical thinking and problem solving in day-to-day operations as well as in emergent situations.
• Communicates appropriately and effectively following chain of command.

JOB REQUIREMENTS

Minimum Education

High school diploma or equivalent

Minimum Work Experience

One (1) year of experience in healthcare setting required

Epic Experience preferred

Required additional Knowledge, and Abilities

Excellent customer service skills

Excellent verbal and written communication skills

Excellent computer skills with knowledge of various software applications including Microsoft office (Word, Excel, Outlook)

Excellent interpersonal skills

Ability to meet demanding deadlines and balance multiple tasks

Ability to work both independently and as part of a team to complete daily assignments by the end of the shift and long term assignments by established deadline.

Detail oriented with excellent organizational and prioritization skills