Job description

Provides general clinic support including but not limited to obtaining prior authorizations, assisting with coordinating internal and external referrals, patient intake and discharge, scheduling of patient appointments, assisting with patient phone calls, providing lab coverage and maintenance of exam rooms and clinical area. Develops and provides patient education as directed by the patient’s provider. Provides oversight of Medical Assistant duties, including but not limited to daily shift assignments, ensuring completion of daily tasks, and training.

ESSENTIAL JOB DUTIES & RESPONSIBILITIES

• Provides general clinic support and assists with pre-visit planning, patient intake and vital signs, screening questionnaires, patient discharge and scheduling.
• Assists with basic clinic procedures not limited to ECGs, injections, vaccines, vision and hearing screenings, ear lavage, and Point-of-Care Testing. Provides lab coverage as indicated.
• Assists with patient referrals, letters, and phone calls.
• Completes continuing paraprofessional training and provides direct patient education based on provider referrals.
• Provides oversight to Medical Assistant team members including daily shift assignments, training, and evaluation.
• Works with Nurse Manager, Nurse Assistant Manager, and the Chief Medical Officer to promote effective coordination, communication, and teamwork among medical team members.
• Under general supervision of nursing management and Chief Medical Officer, follows established company policies and procedures and applies acquired job skills to verify insurance rejections and contact clinics to initiate and receive information to complete prior authorizations for patients.
• Assists clinics and patients with understanding prior authorizations, medical benefits, and if needed, their pharmacy benefits.
• Educates patients regarding requirements for insurance plans to complete prior to authorization.
• Answers inbound inquires related to prior authorizations and insurance claims.
• Completes outbound calls to payors and clinics to assist with prior authorizations.
• Verifies insurance coverage by phone, online, or through electronic system transactions for all new patients and/or changes in coverage.
• Enters patient insurance information under the patient’s account in the EMR
• Demonstrates knowledge and understanding of insurance billing and prior authorization requirements demonstrating analytical thinking.
• Monitors all patients’ prior authorizations to ensure they are initiated and progressing through the pharmacy management system.
• Performs functions that require full knowledge of general aspects of the job.
• Works on assignments that are semi-routine in nature, but recognizes the need for occasional deviation from accepted practice.
• Escalates issues to supervisor or appropriate department for resolution, as deemed necessary.
• Reviews and complies with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations.
• Assists with various projects as assigned by direct supervisor.
• Be the point of contact for external agencies, as needed by the organization. Be the contact person for patients for outside procedure and referrals.
• Participate in the coordination of the external and internal referral processes.

OTHER JOB DUTIES & RESPONSIBILITIES

• Other related duties as assigned.
• Attends departmental and all staff meetings.
• Contributes to departmental and organizational decision making through active participation in the process.
• Works effectively and positively with other team members.

JOB QUALIFICATIONS

• High School Diploma.
• Current Medical Assistant certification and Phlebotomy certification.
• Two or more years of clinical work experience.
• Three or more years with prior authorization experience and coordination of medical services.
• Excellent oral and written communication skills.
• Excellent organizational skills.
• Ability to lift up to 25 pounds.

§ Prefer experience with Electronic Medical Records system.
§ Abide by all regulations that govern Circle Health Services and the Centers for Family and Children.

PHYSICAL DEMANDS/WORK ENVIRONMENT
This job operates in an outpatient health care clinic. While performing the duties of this job, the team member is regularly required to speak and hear. The team member is frequently required to sit, stand, walk, use hands and fingers, and reach with hands and arms. Position is at risk for exposure to bloodborne pathogens as well as other infectious diseases.
This job description is not intended to be a complete list of all responsibilities, duties or skills required for the job and is subject to review and change at any time, with or without notice, in accordance with the needs of The Centers. Since no position description can detail all the duties and responsibilities that may be required from time to time in the performance of a job, duties and responsibilities that may be inherent in a job, reasonably required for its performance, or required due to the changing nature of the job shall also be considered part of the jobholder's responsibility.

The Centers is an Equal Opportunity Employer and all qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability status, protected veteran status, or any other characteristic protected by law.

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