Specialist-Operations WHSC

Operations Specialist

The Operations Specialist coordinates patient referrals at the request of the provider and ensures all necessary information is acquired in a timely manner. This position must work in coordination with the patient, provider, company, and the worker's compensation insurance provider to get all the appropriate information needed to complete the referral. Attention to detail and keeping accurate notes of referral progress is a must. Must have good communication and organizational skills.

In addition to coordinating referrals this position will have other administrative duties including ensuring that all clinical paperwork is complete and scanned into the client portal multiple times a day, sending clients requested records, and assisting the Drug Screen Coordinator with the administrative tasks associated with this service line. This position will also be asked to do other administrative duties as they arise.

The Operations Specialist must be highly organized and able to work with multiple areas within the department.

Minimum Requirements

Education

High School Diploma or equivalent

Experience

Minimum of three (3) years of healthcare related experience with one of a combination of the following: patient finance, insurance benefits, financial assistance programs, public health, social services, administrative support or other health related experience

License/Registration/Certifications

N/A

Other Knowledge, Skills, and Abilities

Typing 50 words per minute minimum, experience with working with different EMR programs, experience with Excel spreadsheets.

Previous experience in Hospital/Physician's office setting with in-depth knowledge and experience.

Must exhibit professionalism and a desire for quality on the job performance and a desire to continuously increase their knowledge.

Exceptional communication, conflict resolution, organization follow-up and skills.

Ability to work in a high volume caseload environment required.

Must have a pleasant, friendly, personality. Must exhibit patience, flexibility, sensitivity, and respect when dealing with public, patients, co-workers and physicians.

Must be an effective communicator and possess a team-oriented spirit.

Strives for 100 % accuracy in all assignments to support high quality patient care.

Careful attention to detail is required to prevent errors in patient data, and reporting.

Core Job Responsibilities

Performs patient referrals timely by completing and submitting documents and discussing with providers, insurance carriers and patients.

Serves as a liaison between companies, physicians, clinical team, patients, pharmacies, vendors, referral sources, and contracted insurance plans.

The Specialist will be instrumental in obtaining written documentation, tracking, and reporting outcomes of each authorization request.

Maintain referral records documenting communication, actions, and other data in the information system

Provides support to clinical staff in order to facilitate the administrative components of the referral

Schedule, confirm, and communicate patient appointments as applicable

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.

Enters or checks patient registration demographics and makes corrections as needed.

Responds to incoming calls regarding status from patients and insurance companies.

Establishes rapport with patients by facilitating open conversation during the referral process. Consistently keeps patients abreast of any additional information related to the referral process.

Provides education and information to co-workers and other staff as it relates to referrals.

Assists provider in identifying appropriate network/healthcare provider to use for referrals as necessary. Referrals are made to authorized providers as specified by the insurer and/or patient requests.

Prioritizes work to ensure that urgent referrals are handled.

Ensures that proper documentation is forwarded as needed and copies of documentation are retained in the patient's medical record. Serves as a resource to patients, providers and staff to facilitate the referral process in a timely and accurate manner.

Problem Solving: Identifies, analyzes, and effectively solves problems.

This job requires the application and interpretation of policies and procedures and the use of independent judgment in a medical setting. The individual must possess the ability to maintain a working knowledge of carrier information/changes and departmental policies and procedures.

Must be able to operate independently to complete all tasks with minimal supervision. Must have good interpersonal skills to interact with individuals in all levels of the hospital and the public. Must have good organizational skills and be able to manage multiple tasks at the same time. Must be accountable for accuracy and timeliness of work. Must be trustworthy and committed to confidentiality. Incumbent has access to confidential hospital and patient information.

Reviews all patient paperwork for accuracy and completeness and scans into EMR system.

Must be attentive to what information is published to the client portal and what should not be.

Perform data entry into the random drug screen EMR system to assist the Drug Screen Coordinator with administrative tasks.

Filing as needed for each administrative task

Assigned other administrative duties needed to help the department run smoothly and grow the business.

Other duties as assigned

Spartanburg Regional Healthcare System