ESSENTIAL JOB DUTIES
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Collaborates with providers and the hospital to schedule hospital procedures and surgeries per the surgery scheduling practice guideline. Obtains insurance prior authorizations and arranges pre-operative testing/appointments, medical clearance (as needed) and post-operative follow-up. Ensures that consents and other required documentation is obtained in a timely manner. Ensures patient confidentiality. (40%)
- Processes insurance company authorization per the preferred method (electronic, fax, telephone) for any referral requiring prior authorization. Notifies specialist office or testing facility of prior authorization approval/authorization number if required. Ensures that all authorizations are communicated to entities applicable in the process, and that relevant documentation is shared according to established practices within GLBHC policies. (15%)
- Responsible for communicating with patients regarding scheduled procedures, surgeries, appointments, and/or tests. Uses appropriate method of communication based upon timing of appointments. (15%)
- Responsible for tracking pending requests for specialists, testing appointments, surgeries, procedures, and prior authorization results. (10%)
- Documents all activity related to referral orders in the EMR including appointment date and time. Monitors Surgery Scheduler “bucket” within the EMR for additional referrals, and patient inquiries. (10%)
- Responsible for implementation of Quality Improvement (QI) initiatives and activities along with the Director of Women’s Health. Compiles and submits QI monitoring/Outcome Improvement Plans and other reports as requested (i.e. surgical site infections, billing tracking of procedures/surgeries). (5%)
- Participates in site provider meetings and implements changes for schedule improvement along with the Women’s Care Site Manager. (5%)
MARGINAL JOB DUTIES
- Assists nursing staff with obtaining insurance prior authorizations for medications and treatments.
- Performs other duties as assigned by Women’s Care Site Manager.
JOB SPECIFICATIONS
- Education: High School graduate or equivalent. Associate’s degree in Medical Office Professional (or similar field) preferred. Pertinent certifications such as Medical Assistant and/or experience may be accepted in lieu of degree
- Licensure: Certification as a Medical Assistant (if applicable).
- Experience: Five years medical office experience working required. Obstetrics and Gynecology experience preferred. Experience in an administrative or supervisory role as well as with surgery scheduling and prior authorizations preferred.
- Skills: Must possess computer skills as well as knowledge of office equipment. Problem identification and resolution, working toward mutually beneficial situations. Self-motivated. Decision maker. Able to function with minimal daily supervision. Organized and detail oriented. Ability to prepare and maintain accurate documentation. Bilingual preferred.
- Interpersonal Skills: Able to communicate effectively, verbally and in writing, with adverse population including patients, providers and referral sources. Team building and excellent organizational skills. Ability to promote confidence, cooperation and good working relationships among employees. Must possess appropriate professional attitude and behavior.
- Physical Effort: Medium
- Hours of Work: Full-time; Flexible and varied.
- Travel: Local travel between GLBHC sites. Some out of service area travel may be required. Reimbursement in accordance with GLBHC travel policy.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, or national origin.
