Job Summary:

The Providence Center Medical Office Specialist Bilingual will 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.

Duties and Responsibilities:

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 party 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.

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.

Review other reports as requested.

Other duties may be assigned.

Requirements:

High School diploma or GED 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.

Bilingual Spanish required.

Care New England Health System (CNE) and its member institutions; Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, and our Wellness Center, are trusted organizations fueling the latest advances in medical research, attracting top specialty-trained doctors, and honing renowned services and innovative programs to engage in the important discussions people need to have about their health.

Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.

EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.