Sr Clinic Operations Representative - Heart, Lung, Kidney Clinics; DC

Job Description

Sr Clinic Operations Representative - Heart, Lung, Kidney Clinics (DC) (2600009Y)

Position reports to the Clinic Operations Manager or Practice Manager. Responsible for ensuring workflow in the clinic, triaging resource issues, involving supervisor or manager as needed. Aid the department in meeting financial objectives. Train and mentor employees within and across departments. Perform all functions of a Clinic Operations Representative (COR). Required to float to other clinics or ROCS for coverage. Supports single specialty ambulatory clinic.

Next step in career ladder is Team Lead.

• Minimum Education: High School Diploma or GED (Required);
  Associate's Degree (Preferred)
• Minimum
  
  Work Experience:
  
  3 years performing billing, patient registration, scheduling, medical insurance verification, insurance screening (Required)
• Required Skills/Knowledge: Broad clinic knowledge, customer service skills, computer skills. Microsoft Office (Word & Excel) preferred. Complete Ambulatory Services training curriculum and pass all competency assessments, including a mock clinic. Typing minimum 35 words per minute.

• Ensure accuracy of scheduling patients using the applicable scheduling system.
• Complete computer‑aided, online registration screen for patients and guardians via telephone or in person in a professional and courteous manner.
• Collect accurate demographic and insurance information. Update systems as needed per department standards for registration accuracy.
• Update scheduling systems with cancellations and no‑shows by COB; reschedule appointments for patients who did not show or for clinic cancellations by providers; schedule follow‑up appointments at checkout when applicable. Open and close schedules as needed.
• Greet patients and parents courteously. Admit patient into the appropriate system based on department policy.
• Obtain required consents and distribute compliance materials (HIPAA Privacy Notice, Patient Rights). Obtain copy of insurance card and photo  be stored in the medical record (copy or scan required). Ensure appropriate forms/documentation are sent to the insurance company and CNMC HIM department. Complete all documentation per policy and procedure.
• Collect and record co‑payments, deposits and full payments, provide payer with receipt; help department meet 85% of the collection target.
• Respond to patient portal work lists (appointment requests, fax queues, email requests, etc.). May include messaging center work lists in the future.
• Verify insurance eligibility using the applicable eligibility system. Ensure managed care carve‑outs (lab and radiology) are adhered to.
• Notify parents of required completed insurance referral form or pre‑authorization prior to scheduled/unscheduled appointments.
• Discuss co‑payment, deposits, full payment or past‑due balance with parents before the scheduled appointment in a professional and courteous manner.
• Counsel parents or refer to the Financial Information Center (FIC) for a payment schedule or method.
• Verify insurance information is complete prior to procedure, collect and verify pre‑authorization/referral information. Goal is to obtain authorizations 5 days in advance; interface with insurance companies as needed. Document activity in 'account notes' following standard.
• Utilize all patient information systems (EPRS, SCI, Cerner, IDX, McKesson, etc.) to verify sync of data.

• Reconcile schedules for upcoming clinic session to ensure accounts are set up for billing and services requiring authorization are flagged; completed 3–4 days before clinic session (5–7 days for procedures).
• Review and print clinic schedules; ensure appropriateness of appointments and back‑fill open slots; completed 3–4 days before clinic session (5–7 days for procedures).
• Verify families received automated appointment reminder calls and complete manual confirmations for those that missed automated messaging; completed 3–4 days before clinic session (5–7 days for procedures).
• Maintain departmental cash controls and deposits; reconcile daily cash receipts/collections and submit to manager.
• Reco…