Office Assistant II, Ashburnham Family Medicine, Heywood Medical Group, 32-Hours, Days and Evenings

Job Title

Under the direction of the Senior/Practice Manager incumbent is responsible for scheduling surgeries (if applicable) and/or referral and prior authorization processing.

Job Summary

As an Office Assistant II you will act as a Referral/Prior Authorization Specialist to ensure referrals are scheduled in a timely manner, maintains tracking and appropriate documentation of referrals and authorizations.

Responsibilities

Behavioral Attributes:

The following behavioral attributes are required: achievement motivation, concern for order, flexibility, initiative, self-confidence, customer service oriented, interpersonal effectiveness, teamwork, analytical thinking and information seeking.

Essential Functions

• Answers telephones, schedules in office appointments, takes messages accurately and routes appropriately
• Completes tasks associated with clinical inbox/ practice buckets (personal, practice referral, medical record and others assigned) proficiently and in a timely manner
• Completes tasks associated with workflow dashboard (Appointments to be rescheduled, appointment tickers, no shows and others assigned) proficiently and in a timely manner
• Arrives patients, verifies all required fields for most current, up to date patient information. Has patient complete appropriate forms, accurately documents information provided by patients in EMR and completes check-in.
• Departs patient from office, provides any necessary patient information and schedules appointments in office and outpatient appointments as needed
• Collects copays/payments, maintains records and reconciles daily deposits
• Verifies insurance coverage and eligibility and negates issues prior to patient visit whenever possible
• Performs a variety of clerical functions to support office such as typing, filing, scheduling appointments, making phone calls and related duties as required or directed.
• Process incoming faxes and daily mail including barcoding and document processing within EMR.
• Schedules and coordinates patient visits and medical procedures, for both inpatients and outpatients
• Registers patients utilizing computer-based registration/scheduling system
• Processes Medical Records incoming and outgoing according to practice guidelines and regulations
• Maintains assigned office and/or clinical supplies. Assures accurate inventory of supplies based on approved levels. Rotates stock as required. Initiates requisitions for re-supply or special items.
• Maintains records, reports, logs and other statistical information as required or directed.

SURGICAL SCHEDULER ROLE/RESPONSIBILITIES

• Schedules office and hospital based medical procedures, for patients with appropriate provider and time/location slot, utilizing appropriate scheduling codes.
• Schedules diagnostic and imaging tests. Schedules office and hospital-based procedures, tests and imaging ensuring available time is utilized to maximum efficiency.
• Interfaces with appropriate vendor staff to ensure all necessary equipment will be on site for office and hospital-based procedures.
• Interfaces with appropriate hospital staff to ensure a cohesive working relationship in providing patient care services.
• Enters notes/special instructions needed for scheduling in EMR.
• Effectively utilizes clinical knowledge when determining if appointment is consistent with the diagnosis/indications indicated by the provider.
• Completes accurate documentation of informed consent with patients for procedures and surgeries as needed.
• Provides accurate, detailed information to patients regarding test preparations, time of patients scheduled arrival, and any other directional information needed; takes appropriate action in responding to questions from patients.
• Confirms patient's insurance provider and obtains all necessary prior authorizations or referrals appropriately.
• Ensures patients have proper medical clearance and pre-surgical testing as needed.
• Completes pre-procedure phone calls and confirms appointment times with patients via telephone
• Demonstrates use of quality improvement in daily operations
• Ensures completion of assessment for advanced directive, including DNR when applicable

REFERRAL AND PRIOR AUTHORIZATION SPECIALIST

• Schedules and coordinates patient referrals to ordered services expeditiously
• Establishes a close working relationship with preferred providers to facilitate scheduling
• Ensures any necessary paperwork, medical records and insurance referrals are processed and provided to specialty provider in advance of patient appointment
• Stays current with insurance referral and prior-authorization requirements
• Obtains necessary prior-authorizations for ordered procedures and diagnostic studies as required
• Issues patients managed care referrals as required
• Has working knowledge of our local network/preferred providers and works with practice providers and PHO to minimize leakage
• Closes the referral loop follow up on assigned open orders-results/consults pending
• Maintains records, reports, logs and other statistical information as required or directed
• Acts as office communications liaison for patients and healthcare providers for referrals and authorizations
• Assists in appeals process as directed
• Verifies insurance coverage and eligibility
• Completes PT-1 forms as required for patient transportation to scheduled services
• Completes tasks associated with clinical inbox/practice buckets (personal, practice referral, medical record and others assigned) proficiently and in a timely manner
• Thoughtfully communicates with patients regarding scheduled services, accurately providing any necessary information such as date, time, prep, pre-registration requirements, etc. in advance of the appointment

RESPONSIBILITY OF ALL JOB ROLES

• Actively participates in quality measure management
• Demonstrates use of quality improvement in daily operations
• Performs all aspects of patient care in an environment that organizes patient safety and reduces the likelihood of medical/health care errors.
• Assists other members of the department as needed
• Attends variety of meetings, conferences, and seminars as required or directed
• Complies with established departmental policies, procedures, and objectives
• Complies with all health and safety regulations and requirements
• Respects diverse views and approaches, and contributes in maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors. Attends all H.E.A.R.T trainings
• Provide coverage when needed at other locations within Heywood Medical Group.
• Completes all Annual Mandatory Education requirements.
• All other duties and locations as assigned.

Statement of Other Duties

This document describes the major duties and responsibilities for this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described.

Qualifications

Job Requirements

Minimum Education

• High School diploma or equivalent required

Minimum Work Experience

• Three (3) year of experience in a medical office preferred

Required Skills

• Excellent written and verbal communication skills
• Excellent customer service skills
• Ability to prioritize tasks in a busy environment
• General comfort level with computers/technology and ability to learn programs as needed.
• Knowledge of Electronic Medical Records preferred and word processing skills.
• Three (3) years of experience in a medical/surgical office preferred.
• Preferred knowledge of medical terminology
• Must be able to work flexible shifts, some evenings & weekends may be required.
• Reliable transportation in order to travel between locations is also required

Functional Demands

Physical Requirements

Exerts up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly to move objects. Frequently reaches (extending hands and arms in any direction), and handles (seizing, holding, grasping, turning, or working with hands).