Call Center and Physician Referral Specialist

University Medical Center of Southern Nevada (UMC); Las Vegas (NV); Sur place; USD 36 000 - 48 000; Plein temps

Résumé du poste

University Medical Center of Southern Nevada (UMC) is seeking a patient services professional to coordinate patient care by handling calls, scheduling, and referrals. The role includes insurance verification and prior authorization responsibilities, plus maintaining accurate records and timely communication for care coordination.

Qualified candidates will have a high school diploma or equivalent and at least three years in a healthcare office setting; Epic experience and Excel skills are a plus;

Qualifications

• High school diploma or equivalent.
• 3 years of experience in health care as a medical office assistant or medical office.
• Experience processing outgoing referrals for Primary Care.
• Experience with insurance eligibility verification and payer portals.
• Experience submitting referrals and prior authorizations through insurance portals.
• Epic experience is a plus.
• Microsoft Excel experience.
• Customer service experience.
• Bilingual preferred; Spanish a plus.

Responsabilités

• Coordinate patient care by answering incoming phone calls and scheduling appointments.
• Modify and confirm patient appointments as needed.
• Process incoming patient referrals and verify insurance eligibility.
• Obtain prior authorizations as required and track status.
• Maintain accurate patient records and communicate with all parties for care coordination.
• Assist with documentation and data entry in scheduling systems.

Connaissances

Customer service

Scheduling

Insurance verification

Prior authorization

Bilingual

Spanish

Formation

High school diploma or equivalent

Outils

Epic

Microsoft Excel

Description du poste

Position Summary

Coordinates patient care by answering incoming phone calls, scheduling, modifying and confirming patient appointments, processing incoming patient referrals, insurance verification, prior authorization responsibilities, maintaining accurate patient records, and ensuring timely communication with all parties to ensure smooth care coordination.

Education/Experience

Equivalent to graduation from high school and three (3) years of experience in the health care field as a medical office assistant or medical office.

Additional Position Requirements

• Minimum one (1) year of experience processing outgoing referrals for Primary Care.
• Minimum one (1) year of experience with insurance eligibility verification, knowledge of payer portal guidelines and requirements when processing referrals and orders, and experience submitting referrals and prior authorizations requests through insurance portals.
• Epic experience is a plus.
• Microsoft Excel experience.
• Customer service experience.
• Bilingual preferred; Spanish is a plus.

Knowledge, Skills, Abilities, and Physical Requirements

Scheduling and authorization procedures; medical terminology; physician medical specialties; community medical/health care services; laws, rules, and regulations governing area of assignment; financial system and insurance requirements; commercial and governmental payers, Medicare plans; health insurance, including HMO and PPO plans; CPT coding, and Medicaid, Medicare, and other third-party insurance carriers billing; Medicare rules and regulations; department and hospital safety practice and procedures; patient rights; age specific patient care practices; infection control policies and practices; handling, storage, use and disposal of hazardous materials; department and hospital emergency response policies and procedures.

Skill In

Communicating effectively with physicians, patients, and other employees; customer services; computerized scheduling system; verbal and written communication, attention to detail, and multitask; verifying benefits and eligibility; forms and applications according to laws and guidelines in area of assignment; preparing technical and statistical reports; performing technical, specialized office support work; using initiative and judgement within established procedural guidelines; setting priorities and meeting critical deadlines; working in a fast-paced, high-volume call center, clinic setting; using computers and related software applications; communicating with a wide variety of people from diverse socio-economic and ethnic backgrounds; establishing and maintaining effective working relationships with all personnel contacted in the course of duties; efficient, effective and safe use of equipment.

Physical Requirements And Working Conditions

Mobility to work in a typical clinical setting and use standard office equipment, stamina to remain seated for extended periods of time and maintain concentration, vision to read printed materials and a computer screen, and hearing and speech to communicate effectively in person and over the telephone. Strength and agility to exert up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this classification.