Job Description

At NorthBay Heath, the Clinic Support Specialist performs a combination of duties encompassing clerical, reception, registration, scheduling, authorization and eligibility, charges and medical records management.The Clinic Support Specialist functions as part of the customer service team in support of the clinical staff and practices.

With appropriate certification as a Medical Assistant (MA) this position would also be responsible for providing direct patient care in support of a provider and/or Registered Nurse (RN) in an ambulatory wound care clinic setting or inpatient setting under the direction and supervision of a licensed physician and/or RN. Under their scope of practice/certification, the MA may provide and assist with wound care upon supervision of a physician and/or Registered nurse.

PRIMARY JOB DUTIES/RESPONSIBILITIES

1. Presents a professional demeanor in appearance and attitude.

2. Ensures smooth operation of the clinic /office practice.

3. Performs secretarial/receptionist duties and general office work including typing, filing, word processing, chart preparation, data base entry and report writing, and maintains department paper and electronic filing systems.

4. Maintains inventory and ordering of appropriate department supplies.

5. Maintains department equipment daily checks as directed.

6. Actively participates in QI/ PI activities.

7. Assists in collection and reporting of statistical data as requested. Maintains timely input of patient data into data base.

8. Operates department photography equipment and maintains patients’ photographic file and medical records.

9. Generates registration and scheduling reports from the appropriate system and disseminates as appropriate.

10. Charges are reconciled and processed for accuracy, statistics etc. and/or entered per department policy.

11. Prioritizes referrals and effectively maintains and handles wait lists according to established criteria and communicates immediately with CN IV / Manager when unable to offer patient an appointment within department defined timeframes.

12. Initiates, verifies and documents eligibility and benefits for all payers including identifying and resolving all managed care and third party requirements prior to first visit for all responsible departments. Utilizes telephone and Internet eligibility sources appropriately. Informs CN IV / Manager of all authorizations that are denied.

13. Schedules appointments and registers patients for wound care, hyperbaric oxygen and infusion services on the phone or in person in accordance with approved department scheduling policies and procedures.

14. Places confirmation or rescheduling calls as appropriate.

15. Checks in the patient for each appointment including verifying and updating patient demographic and insurance/ eligibility information.

16. Reviews the schedule to initiate the pre-registration process. Determines insurance type, initiates authorization and eligibility processes as appropriate.

17. Assists in processing appropriate forms required for billing (e.g. TAR, Medicare forms, Workers Comp forms)

18. Gathers updates and verifies a comprehensive package of registration, demographic and insurance/payer information and ensures accurate entry in to the system for new and existing patients. Communicates patient financial liability regarding co-payments, share of cost, deductibles, and other financial responsibilities as appropriate.

19. Researches and answers inquiries related to referrals, authorization and eligibility, charges, eligibility of benefits (EOB) and denied claims.

20. Collects co-payments, share of cost, deductibles and fees as appropriate, documenting information in system.

21. Maintains and reconciles cash journal on a daily basis. Distributes to appropriate departments according to established timeframes.

22. Performs other duties as assigned.

1. Education High school graduate or equivalent preferred. Medical Assistant certification highly preferred.

2. Licensure: Current AHA certification or equivalent in basic CPR preferred.

3. Experience: One year’s experience in ambulatory care setting preferred. Experience in front office setting including appointment scheduling, medical records processing, referral and authorization processes registration processes and knowledge of health insurance/benefit requirements.

4. Skills: Demonstrated effective time management skills. Demonstrate and maintain current knowledge and skill in providing ambulatory nursing care as appropriate. Strong organizational and written/spoken communication skills essential. Ability to work independently on a variety of complex tasks, managing completing deadlines. Demonstrated working knowledge of Windows and Microsoft Word. Knowledge of medical terminology, and insurance rules and regulations. Detail oriented with typing and computer entry ability and a working knowledge of general office machines required. Bilingual preferred.

5. Interpersonal Skills: Attendance is an essential function of the job. Demonstrated ability to interact positively with all levels of staff, practitioners, employers, insurers and patients. Excellent critical thinking, sound judgment, and problem solving skills essential to respond quickly and manage multiple priorities. Uses effective time management skills and exhibits initiative for spending time productively. Demonstrated ability to work as a team member in developing and promoting high performance work groups.

6. Hours of Work: Monday through Friday between the hours of 8:30 a.m. – 5:00 p.m. – variable

7. Compensation $27 to $33 per hour, based on years of experience doing the duties of the role.