Senior Patient Services Coordinator - Authorizations

ABOUT AUSTIN REGIONAL CLINIC:

Austin Regional Clinic has been voted a top Central Texas employer by our employees for over 15 years! We are one of central Texas’ largest professional medical groups with 35+ locations and we are continuing to grow. We offer the following benefits to eligible team members: Medical, Dental, Vision, Flexible Spending Accounts, PTO, 401(k), EAP, Life Insurance, Long Term Disability, Tuition Reimbursement, Child Care Assistance, Health & Fitness, Sick Child Care Assistance, Development and more. For additional information visit

PURPOSE

Performs advanced Patient Service Coordinator functions and serves as a resource for other business office staff. May train entry level business office staff. Carries out all duties while maintaining compliance and confidentiality and promoting the mission and philosophy of the organization.

ESSENTIAL FUNCTIONS

• Performs all of the tasks of the Patient Service Coordinator as needed or assigned.
• Assists other Business Office staff with front desk duties, which include but are not limited to answering phones, booking appointments, greeting patients, check-in/check-out, end of day processing & documentation, including deposit, etc.
• Performs full patient registration functions which include collecting and entering all patient insurance and demographic information necessary to set up insurance coverage and patient accounts.
• Generates and processes referrals and authorizations.
• Responsible for opening front office and all duties associated with this function.
• Responsible for end of day processing and documentation, including deposit.
• Assists with the initiation of prior authorizations for medications.
• Verifies scheduling accuracy of MyChart appointments.
• Researches and resolves problems with patient accounts in work queues.
• Processes claim denial adjustments to patient accounts.
• Using reports, audits tickets in work queue for missed charges, completeness, accurate coding, etc.
• Performs charge entry functions.
• Communicates with providers regarding coding issues.
• Serves as a resource for other Business Office staff.
• Assists with training of entry level Business Office staff.
• Adheres to all company policies, including but not limited to, OSHA, HIPAA, compliance and Code of Conduct.
• Regular and dependable attendance.
• Follows the core competencies set forth by the Company, which are available for review on CMSweb.
• Works holiday shift(s) as required by Company policy

Must be trained and provide backup coverage in one or more of the following duties:

CBO Site Requests:

• Researches and resolves problems with patient accounts from site requests.
• Works with the providers to communicate coding issues and submit adjustment journals as needed.

CRWQ:

• When working in the charge review work queue, responsible for following workflows consistent with the policies of the Compliance Plan.

Surgery Scheduling:

• Schedules surgeries for physicians at local surgery centers and hospitals.
• Creates and maintains surgery schedules for physicians and notifies them of their schedules.
• Updates EPIC with physician schedules and opens up office time slots when applicable.
• Confirms all surgeries with patients and facilities.
• Works closely with physicians to help keep schedule flowing smoothly throughout the day.
• Obtains authorization with the insurance companies and verifies benefits for in office procedures.
• Performs patient registration functions by collecting and entering demographic and insurance related information into computer system in order to set up patient accounts.

Referrals and/or Prior Authorizations:

• Maintains current knowledge of insurance authorization and/or referral requirements
• Obtains authorizations from insurance carriers in a timely manner.
• Acts as a resource for patients and staff with authorization and/or referral related questions/problems requiring resolution.
• Communicates authorization and/or referral information to patients and specialist offices in a timely manner.
• Serves as a liaison between Primary Care and Specialty offices.
• Responsible for coordinating medical record information for transmission to specialist’s office.
• Responsible for maintaining access to online resources.
• Ensures authorization and/or referral information is properly documented in Epic.
• If aware, informs physician of patient compliance with referral plan.
• Maintains authorizations and/or referrals to ensure that specialty visits are covered (Specialty Offices).
• Coordinates with Primary Care Offices as needed (Specialty Offices).
• Informs physicians and management of any issues causing a delay in authorization process.

OTHER DUTIES AND RESPONSIBILITIES

• Responsible for coordinating surgery details and appointments if applicable.
• Obtains insurance eligibility and benefit details.
• Performs other duties as assigned.

QUALIFICATIONS

Education and Experience

Required: High school diploma or GED. Six or more months of experience working in the office of a healthcare related facility. Experience using a PC in a Windows environment. Proficient in at least one of the following areas: CBO Site Requests, CRWQ, Surgery Scheduling, Hospital Tickets or Referrals.

Preferred: Experience working with ICD-10 and CPT coding.

Certificate/License

If work in the charge review work queue, then must attend and complete all work queue training and successfully pass all tests based on the guidelines listed in the Compliance Plan.

Knowledge, Skills and Abilities

• Excellent verbal and written documentation and communication skills.
• Knowledge of medical terminology,
• Familiarity with procedural and diagnostic coding.
• Familiarity with ICD and CPT coding methodology.
• Knowledge of medical insurance, collections, and appointments.
• Keyboarding ability.
• Excellent customer service skills.
• Excellent computer and keyboarding skills, including familiarity with Windows.
• Excellent interpersonal and problem solve skills.
• Ability to work in a team environment.
• Ability to manage competing priorities.
• Ability to engage others, listen and adapt response to meet others’ needs.
• Ability to perform job duties in a professional manner at all times.
• Ability to align own actions with those of other team members committed to common goals.
• Ability to understand, recall, and communicate, factual information.
• Ability to understand, recall, and apply oral and/or written instructions or other information.
• Ability to organize thoughts and ideas into understandable terminology.
• Ability to apply common sense in performing job.

Work Schedule: Monday - Friday 8AM - 5PM