Clinic Operations Representative - Northern Virginia

Job Description - Clinic Operations Representative - Northern Virginia (250002JO)

Job Description

Provides patient services and administrative support in clinic operations. Interacts with parents, patients, physicians and other staff under moderate supervision in a courteous manner. Assists other employees within the department and in other departments. Collects and verifies all demographic information to ensure accuracy. May provide required notification of scheduled services according to managed care requirements and may be responsible for scheduling patients for specialty appointments.

The position may be required to float to other clinics or ROCs for coverage. The next step in the career ladder is Senior Clinic Operations Rep or Team Lead.

Minimum Education
High School Diploma or GED (Required)

Minimum Work Experience
1 year experience performing billing, patient registration and scheduling, medical insurance verification, insurance screening (Required)

Required Skills/Knowledge
Broad clinic knowledge, customer service skills. Computer knowledge necessary. Microsoft Office experience preferred (Word & Excel). Complete Ambulatory Services training curriculum and pass all competency assessments, including a mock clinic. The ability to type a minimum of 35 words per minute required.

• Demonstrate accuracy of scheduling patients using the applicable scheduling system for the department.
• Complete computer‑aided, on‑line registration screen with parent/guardian via telephone or in person in a professional & courteous manner.
• Collect accurate demographic and insurance information. Update systems as needed in accordance with department standards for registration accuracy.
• Reschedule appointments for patients who did not show or for ancillary services cancellations by providers/technologists. Schedule follow‑up appointments at check‑out if applicable.
• Greet patients and parents courteously. Arrange patient entry into the appropriate system based on department policy.
• Obtain required consents for department & ensure distribution of compliance‑related materials (i.e. HIPAA Privacy Notice, Patient Rights).
• Obtain a copy of insurance card and photo  be stored in medical record (copy or scan activity required). Ensure applicable insurance company and CNMC HIM department receive copies of appropriate forms/documentation. Complete all documentation in accordance with department policy and procedure.
• Respond to patient portal work lists (i.e. appointment requests, fax queues, email requests, etc.).

• Verify insurance eligibility using applicable eligibility system. Ensure managed care carve‑outs (lab and radiology carve‑outs) are adhered to.
• Notify parents of the need for a completed insurance referral form or pre‑authorization prior to scheduled/unscheduled appointments.
• Discuss co‑payment, deposits, payment in full, or past‑due balance collections with parents prior to scheduled appointment in a professional & courteous manner.
• Counsel parents or refer parent to Financial Information Center (FIC) for establishing a payment schedule or method of payment.
• Verify insurance information is complete prior to procedure and collect and verify pre‑authorization/referral information: goal is to obtain authorizations 5 days in advance of service.
• Utilize all systems where patient information may be stored (EPRS, SCI, Cerner, IDX, McKesson, etc.) to verify that systems are in sync.

• Collect and record co‑payments, deposits and payments in full and provide payer with receipt. Responsible for helping department meet 85% of the collection target for the department.
• Maintain departmental requirements regarding cash controls and collections.

• Reconcile schedules for upcoming clinic session to include ensuring that accounts are set up for billing and services requiring authorization are flagged: activity should be completed 3‑4 days in advance of clinic session; areas with procedures requiring authorizations work standard may be 5‑7 days.
• Appropriately clear all walk‑in and ensure scheduled/unscheduled appointments are linked…