Clinical Service Specialist

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Summary

1.0 FTE (40 hours/weekly). Monday-Friday.
1030am-7pm Mon-Thurs, 830-5 Friday.
No weekends or holidays

Job Description

POSITION SUMMARY: Provides complete and accurate patient scheduling, registration, insurance verification, ordering of tests and coordination of applicable screening, diagnostic, physician office and outpatient hospital services.  Capable of coordinating and communicating effectively during increased volumes or with complex patients. Assists with the delivery of direct, non-licensed patient care in accordance with established methods and procedures, under the supervision and guidance of appropriate personnel.

ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:

Registration

• Performs complete and accurate patient registration including but not limited to walk in, check-in, and/or scheduled.
• Demonstrates ability to successfully adapt and perform during times of high volumes and/or high patient acuity.  Demonstrates skill to service both hospital and physician office patients, if necessary. 
• Supports inbound and outbound calls to or from patients, guests, or appropriate parties as needed to provide services.

Patient Liability and Point of Service Collections

• Understands and supports Point of Service Collections. Performs all necessary functions needed to collect patient obligations.
• Refers patient to appropriate person for questions regarding; collections, insurance coverage, and financial assistance.
• Disseminates or discusses information with the patients regarding co-pays, out of pocket expenses, pre-appointment preparation, arrival times, etc.

E-Health Record Verification

• Verifies patient, guarantor, coverage and hospital account information. Performs required referral/authorization processes and enters orders for applicable tests. 
• Understands insurance company coverage and referral/authorization requirements of payors.  Performs electronic and manual verification of insurance coverage and understands how to read and accurately apply electronic insurance responses.
• Prepares and/or releases records or orders in the e-Health record. Scans all necessary documents into appropriate medical record. Understands the importance of patient’s medical information that is documented on paper. Sends all pertinent information to document imaging or heath information management team with in the established time frames.

Compliance/Regulatory

• Completes documentation for compliance and regulatory needs and/or release of orders
• Retains knowledge and abides by all regulatory requirements pertaining to duties of position and overall operation of the Hospital (as applicable).  

Complex Situations and/or Scheduling

• Screens and accurately relays messages using protocols established for emergent, urgent and non-urgent calls. 
• Demonstrates ability to register unscheduled patients requiring a full financial clearance.

Work Queues- Understands how to complete patient and account

• Completes assigned patient scheduling and registration work queues according to performance standards. 
• Ability to resolve work queue issues and missing registration items via electronic medical record. 

Environmental Management

• Completes cleaning tasks utilizing OSHA standards.
• Performs maintenance and/or inventory of equipment and supplies according to unit/department standards
• Maintains appearance of patient care and public areas

Supply Management

• Orders, stocks and distributes supplies to meet the needs of the unit/department
• Aware of cost containment practices and able to access need for changes in utilization

Patient Care/Safety

• Greets and escorts patient and visitors to and from clinic/exam room and prepares patient for visit with provider.
• Initiates patient visit/ follows up after visit when appropriate within scope and competency; following established standards.
• Prepares and assists provider with various procedures within scope and competency; following established guidelines
• Maintains clinical skills necessary to perform duty/job
• Performs clinical functions as required, including any of the following:  Phlebotomy, Pain Management, EKG’s, Holter Monitors, 24 hour Blood Pressure Monitoring, and Point of Care Testing if needed based on departmental needs.

SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:

• May require regular travel to various sites within the region to support operational needs as listed above.
• Other duties as assigned.

JOB REQUIREMENTS

MINIMUM REQUIRED QUALIFICATIONS:

• High school diploma or equivalent
• Completion of educational requirements (additional formal education/training; maximum supervision for initial competency; high degree associated risk factors; yearly competency evaluation and training).
• One (1) year prior experience of Revenue Cycle in a Hospital/Medical Office Setting AND/OR one (1) year administrative/data entry experience in a medical facility, health insurance or business setting.
• One (1) year of clerical, customer service, or administrative support experience in a highly customer-oriented organization.
• One (1) year experience with basic keyboarding, personal computer use, and other office setting equipment.

• A health care provider in good standing with Medicare, Medicaid, and other federal and state health insurance programs, i.e. not excluded from participation in Medicare, Medicaid or any other federal or state health insurance program.

PREFERRED QUALIFICATIONS:

• One (1) year of Epic (or equivalent Electronic Medical Record) experience.
• One (1) year of registration experience, point of service collection, insurance validation, understanding of compliance /regulatory guidelines and order release process(es).
• Epic or equivalent Electronic Medical Record experience.

COGNITIVE REQUIREMENTS

ATTENTION/CONCENTRATION – The following level of ability is essential for the jobholder to focus on certain aspects of current experience and reject others:

• The position requires the ability to attend to a specific stimulus without being distracted by extraneous environmental stimuli.  The individual must be able to attend to environmental detail with the ability to separate essential from non-essential or irrelevant stimuli.  The attention skills required are generally considered to be automatic - - passive, but focused with an intact capacity for select perception.

NEW LEARNING AND MEMORY – The following level of ability is essential for the jobholder to learn and retain material:

• A large portion of this position required reliance on verbal memory and new learning.  Efficiency in processing of verbal information, either in written or spoken form, is a major requirement and prerequisite of the job.  The individual must be able to attend to and process multiple bits of information simultaneously.  The individual must be able to organize and categorize this information effectively so that later recall is feasible.

PROBLEM SOLVING, REASONING AND CREATIVE THINKING – The following level of ability that is essential for the jobholder to think (in order to solve a problem) by combining two or more elements from past experience or imaginative thought:

• The requirement for autonomous problem solving or creativity of thought in the position is minimal.  Problems encountered tend to involve a few concrete variables in or from standardized situations.  Typically involves adhering to a chart or set procedure.

APTITUDES:  The following are essential requirements of the position in relation to job-worker situations.  These items describe how a worker must adapt, adjust, conform or act:

Repetitive work: Ability to continuously perform the same type of work for extended periods of time, according to set procedures, sequence or pace.

Performing under stressful conditions: Ability to perform under stress when confronted with emergency, critical, unusual, or dangerous situations, or in situations in which working speed and sustained attention are critical aspects of the job. Is subject to danger or risk, or to tension as a regular, consistent part of the job.

Variety and change: Ability to perform a variety of duties, often changing from one task to another of a different nature without loss of efficiency or composure involving significant differences in technologies, techniques, procedures, environmental factors, physical demands, or work situations.

Communication:  Ability to exchange information with others clearly and concisely; to present ideas, facts and technical information.

Interpersonal relations: Ability to maintain relationships that facilitate task accomplishment; to cooperate and resolve conflicts; to recognize needs and be sensitive of others.

EQUIPMENT USAGE REQUIREMENTS

Equipment/Tools: Computer, Phone, Copier, Printer, Fax, Office Supplies

Software: Microsoft Office Products, clinical information system

PHYSICAL REQUIREMENTS

Rarely 0-10%; Occasionally 11-35%; Frequently 36-70%; Continuously 71-100%

Body Position/Movement:

• Sit: Continuously
• Stand: Rarely
• Walk: Rarely
• Bend: Rarely
• Push: Rarely
• Pull: Rarely
• Kneel/Squat: Rarely
• Reach: Rarely
• Twist: Rarely
• Balance: Rarely
• Climb: Rarely

Lifting: Degree of physical exertion is:

Light, exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to move objects.

Sensory Abilities specifically required:

• Vision
• Hearing

PHYSICAL ENVIRONMENT

WORKING CONDITIONS: Exposure to hazardous conditions/ materials is negligible.

                       

Disclaimer: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job.  It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards.  The percentages of time spent performing job duties are estimates, and should not be considered absolute.  The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole.  Incumbent must be able to perform all job functions safely.

Disclaimer

KISSELHILL Full Time Posted on 10/16/2024