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Job Description
Job Id:
3201
# of Openings:
1
Title: Managed Care Patient Account Representative
Reports to: Director of Managed Care
FLSA Status: Non-Exempt
Personnel Supervised: None
POSITION SUMMARY:
MINIMAL QUALIFICATIONS:
Minimum of 1-3 years healthcare experience working in a managed care, revenue cycle or billing office setting
Knowledge of medical terminology or concepts is a must
Proficiency in Microsoft Office applications including Word, Power Point, Excel, and Outlook is a must.
High school graduate or equivalent required.
KNOWLEDGE AND SKILLS:
Electronic Health Records
Knowledge of billing practices and billing office functions required, FQHC preferred
Knowledge of medical records, E H R required
Must have good math skills and effective communication skills
Must have good problem-solving skills
RESPONSIBILTIES AND PERFORMANCE EXPECTATIONS include, but are not limited to, the following:
Be familiar with CFHC’s program philosophies, goals and objectives. Be cognizant of and comply with all CFHC’s policies and procedures, as well as state and federal regulations.
Be competent in performing the duties of a referral specialist.
Report as needed to CMO any pertinent information or situations that impact on patient care or CFHC liability.
Attend and participate in mandatory CFHC meetings (Center Specific meetings, Corporate meetings, and other meetings as designated by the CMO or CEO).
Demonstrate ability to work cooperatively with other members of the clinical team. Be supportive of coworkers.
Maintain a neat and professional appearance at all times.
Carry out any other activities deemed appropriate by the CMO or CEO.
Coordinate all aspects of completing referrals ordered by CFHC providers
Complete referrals in a timely manner; STAT referrals must be completed by end of business day, URGENT referrals within 24 hours, and ROUTINE referrals within 72 hours
Obtain appropriate authorizations from insurance companies sending necessary
documentation from the patient’s medical record as required
Schedule referral appointments for patient (when applicable) ensuring proper paperwork is faxed to the specialist or given to the patient to take to the appointment (example, labs, x-ray reports, progress notes)
Notify patient of scheduled referral appointment
Document appropriately and thoroughly
Track all referrals accordingly to improve the quality and continuity of care provided to patients. This includes, but is not limited to, initiating reminder calls to patients prior to their scheduled appointment and obtaining the referral report from the specialist.
Notify the ordering provider and/or Referral Specialist Supervisor of any problems in obtaining a patient’s referral, including issues with obtaining authorizations from third party payors or making appointments with a specialist, patient refusal of a referral, or patient no show to scheduled referral appointment
Maintain specialty provider list including payor sources they accept
Review referral log weekly to ensure completion of all referrals
Other duties as assigned by Referral Specialist Supervisor
PHYSICAL REQUIREMENTS:
Requires 80% or more time spent sedentary.
Independently mobile.
Ability to lift weight equivalents that would be required with repositioning equipment and lifting supplies.
Ability to adapt and function in varying environments of workload, patient acuity, worksites, and work shifts.
Occasional travel required
American with Disabilities Act (ADA) Statement: External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job specific functions (listed within each job responsibility) either unaided or with the assistance of a reasonable accommodation to be determined by the organization on a case by case basis.
Reports to: Director of Managed Care
FLSA Status: Non-Exempt
Personnel Supervised: None
POSITION SUMMARY:
MINIMAL QUALIFICATIONS:
Minimum of 1-3 years healthcare experience working in a managed care, revenue cycle or billing office setting
Knowledge of medical terminology or concepts is a must
Proficiency in Microsoft Office applications including Word, Power Point, Excel, and Outlook is a must.
High school graduate or equivalent required.
KNOWLEDGE AND SKILLS:
Electronic Health Records
Knowledge of billing practices and billing office functions required, FQHC preferred
Knowledge of medical records, E H R required
Must have good math skills and effective communication skills
Must have good problem-solving skills
RESPONSIBILTIES AND PERFORMANCE EXPECTATIONS include, but are not limited to, the following:
Be familiar with CFHC’s program philosophies, goals and objectives. Be cognizant of and comply with all CFHC’s policies and procedures, as well as state and federal regulations.
Be competent in performing the duties of a referral specialist.
Report as needed to CMO any pertinent information or situations that impact on patient care or CFHC liability.
Attend and participate in mandatory CFHC meetings (Center Specific meetings, Corporate meetings, and other meetings as designated by the CMO or CEO).
Demonstrate ability to work cooperatively with other members of the clinical team. Be supportive of coworkers.
Maintain a neat and professional appearance at all times.
Carry out any other activities deemed appropriate by the CMO or CEO.
Coordinate all aspects of completing referrals ordered by CFHC providers
Complete referrals in a timely manner; STAT referrals must be completed by end of business day, URGENT referrals within 24 hours, and ROUTINE referrals within 72 hours
Obtain appropriate authorizations from insurance companies sending necessary
documentation from the patient’s medical record as required
Schedule referral appointments for patient (when applicable) ensuring proper paperwork is faxed to the specialist or given to the patient to take to the appointment (example, labs, x-ray reports, progress notes)
Notify patient of scheduled referral appointment
Document appropriately and thoroughly
Track all referrals accordingly to improve the quality and continuity of care provided to patients. This includes, but is not limited to, initiating reminder calls to patients prior to their scheduled appointment and obtaining the referral report from the specialist.
Notify the ordering provider and/or Referral Specialist Supervisor of any problems in obtaining a patient’s referral, including issues with obtaining authorizations from third party payors or making appointments with a specialist, patient refusal of a referral, or patient no show to scheduled referral appointment
Maintain specialty provider list including payor sources they accept
Review referral log weekly to ensure completion of all referrals
Other duties as assigned by Referral Specialist Supervisor
PHYSICAL REQUIREMENTS:
Requires 80% or more time spent sedentary.
Independently mobile.
Ability to lift weight equivalents that would be required with repositioning equipment and lifting supplies.
Ability to adapt and function in varying environments of workload, patient acuity, worksites, and work shifts.
Occasional travel required
American with Disabilities Act (ADA) Statement: External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job specific functions (listed within each job responsibility) either unaided or with the assistance of a reasonable accommodation to be determined by the organization on a case by case basis.
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