Outpatient Consult Representative- Reach and Grow Clinic, LLC

Job Details

Description

POSITION: Kern Medical Surgery Center, LLC.

Outpatient Consult Representative – Reach & Grow Clinic

$21.7563 - $26.757 Hourly

Job Description

Under direct supervision of the Clinic manager, this position is responsible to obtain and enter requests for authorization of medical treatments accurately within electronic systems utilized; this includes verification of member eligibility, demographics, health plan identification, appropriate entry of referring and requested providers, diagnosis, and procedure coding based on referral submission.

Essential Functions

• Interacts with other departments, clinic personnel, and outside providers in a professional, timely, and friendly manner, to create and maintain a positive relationship with our internal and external customers.
• Maintains incoming referral submissions on a continuous basis throughout the day.
• Keeps efficient daily sorting and distribution of pending referrals and documentation of each requested referral submission for possible stat and/or urgent referral submission every 30 minutes.
• Accurately classify requested referrals based on urgency indicated by the referring provider or member
• Verifies the member eligibility by contacting Health Plan eligibility websites.
• Communicates with physician offices, processing staff and other departments as needed to ensure collaboration and open discussion regarding referral process. Including responding to messages from internal and external customers within next business day.
• Communicate new or termed member status with the Eligibility department, in efforts to maintain up to date eligibility status in systems utilized.
• Verifies and enters the requested referral submissions in the electronic systems with high accuracy.
• Excellent typing and transcription skills, including familiarity with medical terminology.
• Knowledge of computer skills, including efficient data entry capabilities.
• Maintains current basic knowledge of rules, regulations, policies, and procedures relating to prior authorization process.
• Adapts to regulation and necessary departmental procedure changes.
• Complies with HIPAA regulations and maintains the patient confidentiality. Annual training required.
• Compile and document good faith attempts in obtaining medical records for each requested referral when there is lack of information.
• Other duties as assigned.
  
  

Qualifications

• High school graduate or GED certification, required.
• On year medical clerical office experience, obtaining medical authorizations.
• Typing certificate of 40 wpm, preferred.
• Familiar with medical terminology.
• Able to demonstrate proficiency in computer systems.
• Able to organize and prioritize workload.
• Able to multi-task.
• Must be a motivated self-starter.