MEDICAL OFFICE SPECIALIST - NOPG PT ACCESS
Status: Full Time
Shift: 730a-430p, 8a-5p
College degree or a minimum of one (1) year experience and working knowledge of healthcare front desk operations consisting of computer data entry and excellent telephone skills or one (1) year experience of customer service required.
2. Specialized or Technical Education Required:
High school diploma or equivalent. Ability to read, understand and follow oral and written instructions. Ability to speak clearly and concisely with a pleasant voice. Ability to handle stressful situations. Ability to establish and maintain effective working relationships with patients, employees and the public.
3. Manual or Physical Skill Required:
Requires manual dexterity sufficient to operate keyboard, telephone, copiers, and such other office equipment as is necessary. Vision must be correctable to 20/40 and hearing must be in the normal range for telephone contact. It is necessary to view and type on computer screens for long periods. Work may also require sitting for long periods of time as well as stooping, bending and stretching for files, supplies, or other materials. Must be able to occasionally push a patient/visitor in a wheelchair when needed.
4.Physical Effort Required:
- The Medical Office Specialist ensures timely and safe access to medical care by completing patient scheduling, insurance verification and registration processes in an efficient, accurate and timely manner and according to the department guidelines.
- The Medical Office Specialist supports the Patient Access Department role in the revenue cycle by scheduling according to patient/provider’s request, reviewing insurance documents verifying coverage, updating all insurance information in the patient’s registration, estimating financial responsibility and collecting payments according to the Patient Access and Clinic policies and procedures.
- The Medical Office Specialist is responsible for communicating the purpose of and secures patient’s signatures as required by department procedures on required documents.
- The Medical Office Specialist contacts patients and provider’s office by phone using excellent customer service to obtain patient for reasons including, but not limited to demographic and insurance information in order to support timely and accurate billing of all payers. Performs insurance verification and authorization/pre-certification processes (including but not limited to careful review of the Real Time Eligibility system, as well as, clear communication with insurance company representatives) for all NOPG patients according to the Patient Access Department guidelines.
- The Medical Office Specialist demonstrates basic knowledge of payer types including, but not limited to, Commercial, Medicare, Medicare Advantage, Medicaid, Medicaid Bayou Health Plans, Other Governmental, Managed Care, Worker’s Compensation and Self Pay in order to schedule, verify coverage, secure authorization, provide notification, and register patients according to the department procedures and payer requirements.
- The Medical Office Specialist demonstrates verbal understanding of basic terminology as it relates to insurance guidelines, including but not limited to Co-payment, Co-Insurance, Deductible, Maximum Out of Pocket, Allowable/Allowed amount, Payable Rates, Payer Notification, Pre-Certification, Prior Authorization, Guarantor, Primary/Secondary/Tertiary Coverage, Coordination of Benefits and Explanation of Benefits.
- The Medical Office Specialist documents in appointment and/or account notes, as well as, any appropriate comment fields as instructed in relation to scheduling, insurance verification or registration of the patient.
- The Medical Office Specialist provides back up to other clinics when needed.
- The Medical Office Specialist interacts with relevant departments including but not limited to Ancillary Departments, Revenue Integrity, Financial Services, Information Technology, Health Information Management to problem solve and coordinate any concerns related to patient identification, registration, scheduling, insurance verification or billing issues.
- The Medical Office Specialist assists in patient conflict resolution to ensure timely access to care, as well as, to facilitate a positive patient experience.
- The Medical Office Specialist is responsible daily for working clinic assigned workques to resolve account errors and claim edits timely and accurately to support the facility’s financial goals.
- The Medical Office Specialist complies with all Patient Access Department and clinic safety, environmental and infection control policies and procedures, as well as, the clinic’s objectives and quality assurance programs.
- The Medical office Specialist follows the North Oaks Health System’s Compliance Program and Federal and State Regulatory Guidelines.
- The Medical Office Specialist expedites patient flow throughout the clinic visit and works with clinic office staff to ensure patients are seen and discharged in a timely manner and following guidelines set by the Performance Management Department for patient experience.
- The Medical Office Specialist is responsible for scanning patients’ insurance cards and driver’s licenses/form of identification, faxed benefits, any paperwork/forms to support the visit, such as but not limited to, authorization/referral form, workman compensation paperwork, coordination of benefits form into the practice management system under the patient’s account in the EMR.
- The Medical Office Specialist is responsible for pre-registering patients with preferred language and make the determination if an interpreter is needed. The Medical Office Specialist is responsible for working the interpreter report daily to ensure the interpreter is scheduled to be onsite, appointment with interpreter needs to be scheduled within 48 hours of the patient’s appointment.
- The Medical Office Specialist are responsible for maintaining their website accuracy and keeping up with their individual passwords.
- The Medical Office Specialist maintains the appearance of the waiting/lobby area. Calling housekeeping when necessary.
- The Medical Office Specialist discusses problems and/or confidential information only in appropriate setting and only with appropriate personnel.
- The Medical Office Specialist responds to inquiries from patients, relatives, physicians, insurance companies and the general public quickly and efficiently by actively listening and taking appropriate action.
- The Medical Office Specialist performs appropriately in difficult situations by remaining calm, professional and notifying appropriate personnel and initiating appropriate action.
- The Medical Office Specialist keeps any confidential documents secure and out of public view.
- The Medical Office Specialist maintains par level of supplies and communicates to his/her Leader when supplies are needed.
- The Medical Office Specialist ensures front desk equipment is functional and ready for service, including paper levels in copier, printers and fax machines.
- The Medical Office Specialist establishes effective relationships with co-workers in their own department, as well as, other departments.
- The Medical Office Specialist assists others and shows willingness to work as a team player
- The Medical Office Specialist is responsible for working their individual clinic referrals daily.
- The Medical Office Specialist is to review and verify the patient’s primary care provider in the clinic’s practice management/EHR system at each visit. Any changed indicated are to be updated in patient’s electronic record.
- The Medical Office Specialist is responsible for pulling and preparing patient charts prior to appointment, as well as, identifying any missing items needed for scanning or updating in record.
- The Medical Office Specialist being part of the revenue cycle team will assist on working denials when needed.
- The Medical Office Specialist is responsible for responsible for reconciling all clinic daily encounters, deposit detail and any other necessary paperwork to complete the daily packet.
- The Medical Office Specialist is responsible for the complete and accurate entry of all Patient Information into the clinic’s EMR including but not limited to:
e.Clinic Deposits/Deposit Validation
f.Preferred Language/Interpreter Needs
g.Release of Information
h.Patient Rights and Responsibilities
i.Conditions of Treatments
k.Mail/Package Receipt and Delivery
l.Coordination of Benefits
m.Preference of Communication
n.Current Payer information
33. The Medical Office Specialist communicates regularly with patients in the clinic waiting area and ensures that the patients are fully informed of appointment delays. When the delay becomes significant, the Medical Office Specialist will work with the Provider Care Team to offer the patient an alternate appointment.
34. The Medical Office Specialist is responsible for maintaining adequate cash flow by balancing and reconciling payments,) balancing and generating total collections for the day. The Medical Office Specialist is responsible for running credit card payment report daily in order to balance and confirm. Deposit for the bank is to be completed daily and brought to cashier’s office no later than 10am the following morning. Once the Medical Office Specialist receives the bank deposit bag back, they are responsible for confirming the generated deposit in the appropriate format. The Medical Office Specialist is responsible for maintaining a professional demeanor and confidentiality at all times with patients, care givers, visitors, physicians and co-workers.
35. The Medical Office Specialist enhances professional growth by participating in education programs, attending staff meetings and participating in committees as required.
36. The Medical Office Specialist could serve in the role as Patient Access Superuser with the responsibility of being the main source of support for other MOSs in their role. They are required to attend meetings to help in planning and strategizing with other departments to assist in resolving revenue cycle problems. Superuser will be responsible for communicating updated processes and changes to team members as it relates to Patient Access Operations and measures ongoing effectiveness.
37. The Medical Office Specialist will assist with review, monitoring and working the no show, wait list, and cancelation report and identify opportunities for continuous quality improvements. The Medical Office Specialist is responsible to following up with patient to reschedule from these reports.
38. The Medical Office Specialist performs other duties for which the particular employee is qualified, as necessary, to assist in the efficient operation of the clinic.
39. The Medical Office Specialist utilizes the 4 Cs in all interactions.