Outpatient Consult Representative, Full-Time, LLC - Clinics - Bilingual Preferred

Kern Medical•Bakersfield, CA

5d•Onsite

About The Position

Under supervision, submits required necessary documentation to insurance companies in order to obtain required prior authorization for patient care and/or treatment in addition to performing basic registration functions for the capture of pertinent demographic and insurance/payer information as well as scheduling activities. Outpatient Consult Representatives will be responsible for prioritizing notifications received for pending consults, processing consults timely, ensuring that patient insurance information is accurate and that authorizations are in line with coordinated benefits, as well as utilizing all resources available to obtain swift approvals to ensure patient safety and continuity of care. Outpatient Consult Representatives will additionally be responsible for answering phones, directing patient calls to the appropriate departments when necessary and scheduling appointments for multiple different physicians, providers, specialties, clinics, and locations.

Requirements

High School Diploma, G.E.D. or equivalent.
One (1) year of outpatient clinic or medical office experience performing scheduling and/or authorizations OR an equivalent combination of education, training, or experience sufficient to successfully perform the essential duties of the job.
Knowledge of State and federal government funding programs such as Medicare, Medi-Cal, CCS, TRICARE/CHAMPUS, Workers’ Compensation, and commercial insurance payers.
Knowledge of Billing and reimbursement guidelines and methodologies for state and federal government and non-government payers.
Knowledge of Medical and insurance terminology.
Knowledge of HIPAA privacy and compliance practices.
Ability to communicate effectively both orally and in writing sufficient to perform the essential functions.
Ability to read, understand, and apply policies and guidelines.
Ability to obtain information from a variety of sources, including patients and families.
Ability to use computers and various software to accomplish work.
Ability to establish and maintain effective working relationships with patients, families, and other internal and external customers.
Ability to use tact and empathy in working with patients and families under stressful situations.
Ability to perform work effectively with frequent interruptions.
Ability to perform multiple tasks in a fast-paced environment.
Ability to lift, carry, push or pull files.
Ability to sit at work station for prolonged periods of time.

Nice To Haves

Bilingual Preferred

Responsibilities

Submits necessary documentation to insurance companies in order to obtain required prior authorization for patient care and/or treatment.
Tracks and follows up on outstanding requests for authorization.
Answers patient phone calls, reviews process, and schedules appointments for exam or follow up.
Enters all patient demographic information into electronic patient record system; uses other department applications for eligibility and authorization.
Screens referrals and informs referring physician offices, patients and their families about hospital policies and procedures regarding method of payment sources for services rendered.
Documents funding information from patients and provides information on available funding resources; refers patients to financial counselors when funding is not in place.
Uses payer resources and websites to explore and assess eligibility.
Assist with training of staff members.
Works in collaboration with scheduling and registration to identify and resolve issues and/or barriers.
Submits and responds to requests for information and inquiries related to authorization/scheduling processes, policies, and/or other related information; researches and resolves customer problems.
Performs other job-related duties as required.