Medical Office Specialist/Bilingual

Department: TPC-Client Access Center Site.
Operating Unit The Providence Center
Location: Providence, RI
Job ID: 6125
Job Status: Full Time
Shift: Days
End Date:

The Providence Center

Job Title: MEDICAL OFFICE SPECIALIST

Division: Administration

Department: All departments

Location: Various

Reports To: Office Manager, Client Support Services

SUMMARY
Assist clinicians in managing client appointment schedule. Ensure clinician schedules are filled with the optimum number of client appointments. Execute FTK strategies for assigned clinicians. Obtain required insurance authorizations for scheduled appointments. Contact insurance companies as required. Verify that client events have been logged correctly to ensure proper billing (Confirmed Event Report). Problem solve unconfirmed events utilizing the Problem Event Report. Assist clinicians administratively to increase overall program productivity.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

Perform a variety of duties to support clinical staff in the department.

-Review daily and weekly schedules of assigned clinical staff to ensure that client appointments are pre-scheduled to meet targeted utilization levels.

-Identify gaps in clinician schedules and coordinate filling schedule with clinician.

-Anticipate client cancellations and “no shows” and ensure that over scheduling of client appointments occurs to maintain full clinician schedules.

-Review Reminderpro reports daily for assigned staff to assess impact on assigned staff schedules. Make confirmation calls to clients when required.

-Meet with consumers to verify insurance coverage and amount of outstanding deductible, obtain necessary pre-authorizations and gather initial demographic data and complete administrative admission forms.

-Contact insurance and managed care companies, and other reimbursement sources pertaining to authorization for services and benefits, as appropriate. Ensure authorizations have been obtained.
-Troubleshoot RIte Care billing and authorization problems.

-Answer in-house questions regarding insurance authorizations and consumer financial status.

-Update insurance information in computer through blue update as required. Notify all departments of changes in insurance.

-Create and maintain cancellation lists of potential replacement appointments with clinicians, where appropriate. Utilize list to fill openings caused by cancellations.

-Oversee the general process of third part billing for accuracy and timeliness.

-Review and disposition logged events that “do not bill” daily utilizing the Confirmed Event Report. Problem solve with clinicians and/or billing department as required.

-Research and troubleshoot reimbursement issues related to the Event Problem Report. Problem solve with clinicians and billing department as required.

-Contact insurance and managed care companies, and other reimbursement sources pertaining to authorization for services and benefits, as appropriate. Ensure authorizations have been obtained in support of client appointments.

-Check schedule the day before to ensure outstanding balances and prior authorizations are in place for services being performed.

-Ensure up to date knowledge about contracts and the number of allowable visits; advise clinician when authorization for more sessions is needed.

-Assist clinical staff administratively as required.

-Provide training to other support staff as needed.
Cover as needed for other staff during staff vacancies, absences, vacations, leave of absences,

Bilingual Medical Office Specialist Only

-Serve as a resource to staff regarding the Hispanic/Latino community.

-Provide education and communicate on community resources and cultural matters.

-Interpret/translate both language and cultural concerns for staff and other community service providers, as appropriate.

Maintain cooperative relationships with other employees, consumers and the public.
-Treat consumers and peers with respect.

-Work in cooperation with co-workers and supervisory staff.
-Deal with co-workers regarding problems in a constructive manner.
-Accept and use direction and supervision.
-Benefit from constructive criticism.
-Ensure no complaints received by peers, supervisors and the public.

Attend trainings and conferences, participate on Center committees.
-Provide feedback to staff on the content of educational programs attended.
-Attend mandatory in-service trainings and other trainings required.

OCCASIONAL DUTIES
:
-Review other reports as requested.

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or

ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Incumbent must be able to multi-task. Attention to detail and strong organization skills are required. Sustained and consistent follow-up on required actions is necessary to be successful. Must be a team player with strong interpersonal skills. Requires assertive style to coordinate successful completion of responsibilities. Must be sensitive to the client population served by The Providence Center.

EDUCATION and/or EXPERIENCE
High school diploma with a business background and two years experience with third party reimbursement; or equivalent combination of education and experience. Must possess good typing skills as well as good spelling and grammar. Excellent communication skills required. General computer experience also required.

LANGUAGE SKILLS

Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to effectively present information in one-on-one and small group situations to consumers and employees.

MATHEMATICAL SKILLS
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.

REASONING ABILITY
Ability to apply commonsense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel objects, tools, or controls and talk or hear. The employee frequently is required to stand, walk, sit, and reach with hands and arms. Specific vision abilities required by this job include close vision and the ability to adjust focus.
 

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.