Job Description

At SCP Health, what you do matters

As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.

Why you will love working here:

• Strong track record of providing excellent work/life balance.
• Comprehensive benefits package and competitive compensation.
• Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect.

RESPONSIBILITIES:

• Work efficiently and in a professional manner utilizing multiple forms of engagement (blended inbound/outbound calls, chat, SMS/Text, and email) in a fast paced and challenging contact center environment across multiple lines of business.
• Manage general inquiries, track appointments, remind patients of appointments, and follow all processes and procedures while demonstrating sensitivity to any issues.
• Serves as a navigator to the clinic/hospital for insurance companies or insurance utilization review department by providing clinical information to obtain pre-certification from payers/adjusters/nurse case managers for workers’ compensation referrals.
• Intake accurate collection of data to complete the coordination of care/referral for program service lines (occupational health services and workers compensation visits).
• Assist and track referrals/appointment scheduling, prior authorizations, and/or insurance billing verification, when applicable for tests/procedures, including surgical procedures, diagnostic procedures, provider appointments, outpatient rehab services, etc.
• Assemble information concerning referral needs to assist with expediting and coordinating care.
• Per client referral guidelines, provide information to appropriate parties to assist with referral navigations/care coordination within client’s health system/hospital.
• Responsible for staying abreast of state specific worker’s compensation and occupations health laws and regulation.
• Check eligibility and obtain authorization for ordered services via insurance companies or acceding vendor portals.
• Track and reconcile patient referral orders for assigned areas with follow through to completion, such as return to work regular duty or maximum medical improvements (MMI).
• Contact utilization review organizations and insurance companies (adjusters and nurse case managers) to ensure prior approval requirements are met. Present necessary medical information such as clinical notes, orders, and/or referrals for said services.
• May assume advocate role on the patient's behalf with the carrier to ensure approval of the necessary services for the patient in a timely fashion.
• Utilize client department service lines and identified service providers to coordinate care. Establish and maintain relationships with identified service providers, work comp adjusters and nurse case managers.
• Ensure that referrals are addressed in a timely manner and track all referral outcomes.
• Communicate and remind patients, employers, adjusters, and nurse case managers of scheduled appointments.
• Meet key performance goals including call handling metrics, quality performance, and attendance.
• All other duties as assigned.

QUALIFICATIONS:

Education

• High School Diploma or equivalent required
• Medical Office Administration experience or Medical Assistant Certification preferred

Certification and Licenses:

• Medical Assistant Certification preferred

Previous Experience:

• Two years’ patient care coordination or patient scheduling experience or equivalent
• One year customer service experience
• Previous occupational health, or workers compensation experience preferred
• EMR experience a plus

Knowledge Skills and Abilities:

• Thrives working in fast based, changing, and growth-oriented environment
• Ability to quickly learn new processes and workflows
• Ability to listen to caller while entering data and documenting information accurately
• Strong communication skills, oral and written
• Great active listening skills
• Patient and empathetic attitude
• Excellent interpersonal skills
• Computer literate with attention to detail and the ability to learn new software applications and methods of engagement
• Problem solving abilities
• Excellent customer service skills
• Bilingual a plus but not required

Pay Range:

13.00 - 19.00 USD per hour

This range represents the anticipated base salary for this role. Actual compensation will be determined based on experience, qualifications, and internal equity considerations.

We offer a comprehensive benefits package designed to support your health, financial well-being, and work-life balance, including medical dental, vision insurance, a 401(k) plan with a company match, paid time off and holidays, professional development support, and employee wellness resources.

Visit our website for further information. https://myscpbenefits.com/

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