Clinic Operations Representative
Fairfax, VA 
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Job Description
Clinic Operations Representative (190000LS)

This position reports to the Clinic Operations Supervisor or Clinic Operations/Practice Manager. Provide patient services and administrative support in clinic operations. Interacts with parents, patients, physicians and other staff under moderate supervision in a courteous manner. Provide assistance to
other employees within their department as well as other departments. Collect and verify all demographic information to ensure accuracy. May provide required notification of scheduled services according to managed care requirements. May be responsible for scheduling patients for specialty appointments. Position may be required to float to other clinics or ROCs for coverage. Next step in career ladder is Senior Clinic Operations Rep or Team Lead position.

Qualifications
Minimum Education
High School Diploma or GED
Minimum Work Experience

1 year of related experience. Experience performing billing, patientregistration, and scheduling, medical insurance verification, insurancescreening. Experience in health care setting preferred.

Required Skills/Knowledge

Broad clinic knowledge, customer service skills. Computer knowledgenecessary. Microsoft Office experience preferred (Word & Excel). CompleteAmbulatory Services training curriculum and pass all competency assessments,including a mock clinic. The ability to type minimum of 35 words per minuterequired.

Functional Accountabilities

Patient Services

  1. Demonstrate accuracyof scheduling patients using the applicable scheduling system for thedepartment.
  2. Complete computeraided, on-line registration screen with parent/guardian via telephone or inperson in professional & courteous manner.
  3. Collect accuratedemographic and insurance information. Update systems as needed in accordancewith department standards for registration accuracy.
  4. Reschedule appointmentfor patients who did not show or for the ancillary services cancellations byproviders/technologist. Schedule follow up appointments at check out ifapplicable.
  5. Greet patients andparents courteously. Arrive patient in appropriate system based on departmentpolicy.
  6. Obtain requiredconsents for department & ensure distribution of compliance relatedmaterials (i.e. HIPPA Privacy Notice, Patient Rights). Obtain copy of insurancecard and photo ID to be stored in medical record (copy or scan activityrequired). Ensure applicable insurance company and CNMC HIM department receivecopies of appropriate forms/documentation. Complete all documentation inaccordance with department policy and procedure.
  7. Respond to patientportal work lists (i.e. appointment requests, fax queues, email requests, etc.May include messaging center work lists in the future).

InformationVerification

  1. Verify insuranceeligibility using applicable eligibility system. Ensure managed care carve outs(lab and radiology carve outs) are adhered to.
  2. Notify parents of theneed for completed insurance referral form or pre-authorization prior toscheduled/unscheduled appointments.
  3. Discuss co-payment,deposits, payment in full, or past due balance collections with parents priorto scheduled appointment in a professional & courteous manner.
  4. Counsel parents orrefer parent to Financial Information Center (FIC) for establishing paymentschedule or method of payment.
  5. Verify insuranceinformation is complete prior to procedure and collect and verifypre-authorization/referral information: goal is to obtain authorizations 5 daysin advance of service.
  6. Utilize all systemswhere patient information may be stored (EPRS, SCI, Cerner, IDX, McKesson,etc.) to verify that systems are in sync.

Cash Collection

  1. Collect and recordco-payments, deposits and payments in full and provide payer with receipt.Responsible for helping department meet 85% of the collection target for thedepartment.
  2. Maintain departmentalrequirements regarding cash controls and collections.

Billing Preparation

  1. Reconcile schedulesfor upcoming clinic session to include ensuring that accounts are set up forbilling and services requiring authorization are flagged: Activity should becompleted 3-4 days in advance of clinic session; Areas with proceduresrequiring authorizations work standard may be 5-7 days.
  2. Appropriately clearall walk-in and ensure scheduled/unscheduled appointments are linked toscheduling system.

Office Support

  1. Answer telephone and addresscaller needs appropriately. Avoid transferring calls for better service tofamilies. Meet department standards relative to ACD policies if applicable.Manage voice mail messages within same business day.
  2. Distribute mail. Maywork returned mail as needed.
  3. All staff areresponsible for information distributed via e-mail. Staff should check workemail a minimum of 3 times daily and respond to inquiries within 24 hours (ornext business day).
  4. Maintain office filesand office supplies at PAR levels.
  5. Maintain cleanreception area and work space.
  6. Other support asneeded.
Safety
  1. Speak up when teammembers appear to exhibit unsafe behavior or performance
  2. Continuously validateand verify information needed for decision making or documentation
  3. Stop in the face ofuncertainty and takes time to resolve the situation
  4. Demonstrate accurate,clear and timely verbal and written communication
  5. Actively promotesafety for patients, families, visitors and co-workers
  6. Attend carefully toimportant details - practicing Stop, Think, Act and Review in order toself-check behavior and performance
Organizational Accountabilities

OrganizationalCommitment/Identification

  1. Partner in the missionand upholds the core principles of the organization
  2. Committed to diversityand recognizes value of cultural ethnic differences
  3. Demonstrate personaland professional integrity
  4. Maintainconfidentiality at all times
Customer Service
  1. Anticipate andresponds to customer needs; follows up until needs are met
Teamwork/Communication
  1. Demonstrate collaborativeand respectful behavior
  2. Partner with all teammembers to achieve goals
  3. Receptive to others'ideas and opinions

PerformanceImprovement/Problem-solving

  1. Contribute to apositive work environment
  2. Demonstrateflexibility and willingness to change
  3. Identify opportunitiesto improve clinical and administrative processes
  4. Make appropriatedecisions, using sound judgment

CostManagement/Financial Responsibility

  1. Use resourcesefficiently
Search for less costly waysof doing things

Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individual with Disabilities.

 

Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
High School or Equivalent
Required Experience
1+ years
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