Position Summary:
The Administrative Assistant provides support for the Clinic Administrator duties, which may include but are not limited to patient admission, completion of patient demographic sheets, preparation of claim forms, keeping record of patient appointments and visits, among others. This key individual will collaborate with the Clinical Administrator for the effective completion of claims, inventory preparations and ordering necessary supplies.
Essential Functions:
1. Responds calls and arranges proper solutions.
2. Receives patients for admission and completes initial demographic forms. Completes patient information and billing forms such as: health plan information, authorization for disclosure, payment options, guides regarding treatment, etc.
3. Assists in initial patient orientation about services and offerings as needed. Collaborates in the preparation of certifications solicited by patients and plans for patient signature is necessary.
4. Collaborates in the preparation of deductibles and/or co-payments as established by the patients’ health plan. Maintains and monitors the accuracy of patient admission registries within the system.
5. Completes reconciliation of deductibles and provides timely reports for the Billing Department.
6. Organizes and archives records, as well as ensures that patient records are up to date.
7. Assembles and monitors a proper stock of materials and forms for clinic daily utilization.
8. Collaborates with the EMR audit process.
9. Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable.
10. In addition, all other duties assigned by the manager and/or supervisor.
Education:
· Associate degree in secretarial science preferred
· High School degree
Experience:
· Minimum 2 years of experience in administrative assistant position or similar.
Knowledge:
· Knowledge in medical billing, preferably in healthcare setting.
· Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum.
Read LessPosition Summary:
The Administrative Assistant provides support for the Clinic Administrator duties, which may include but are not limited to patient admission, completion of patient demographic sheets, preparation of claim forms, keeping record of
patient appointments and visits, among others. This key individual will collaborate with the Clinical Administrator for the effective completion of claims, inventory preparations and ordering necessary supplies.
Essential Functions:
1. Responds calls and arranges proper solutions.
2. Receives patients for admission and completes initial demographic forms. Completes patient information and billing forms such as: health plan information, authorization for disclosure, payment options, guides regarding treatment, etc.
3. Assists in initial patient orientation about services and offerings as needed. Collaborates in the preparation of certifications solicited by patients and plans for patient signature is necessary.
4. Collaborates in the preparation of deductibles and/or co-payments as established by the patients’ health plan. Maintains and monitors the accuracy of patient admission registries within the system.
5. Completes reconciliation of deductibles and provides timely reports for the Billing Department.
6. Organizes and archives records, as well as ensures that patient records are up to date.
7. Assembles and monitors a proper stock of materials and forms for clinic daily utilization.
8. Collaborates with the EMR audit process.
9. Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable.
10. In addition, all other duties assigned by the manager and/or supervisor.
Education:
· Associate degree in secretarial science preferred
· High School degree
Experience:
· Minimum 2 years of experience in administrative assistant position or similar.
Knowledge:
· Knowledge in medical billing, preferably in healthcare setting.
· Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum.
Read LessPosition Summary:
The Health Professional 1 provides telephonic customer service and timely resolves inquiries regarding patient care, eligibility, benefits, and claims, among others. This key individual provides follow up for patients to assure continuity of care and efficiency of overall services. This employee is not responsible for conducting any UM review activities that require interpretation of clinical information.
Essential Functions:
1. Verifies patient eligibility and arranges appointments when needed.
2. Provides assistance via verbal and written correspondence for subscribers, patients-relatives, providers, account
representatives, among others.
3. Authorizes initial patient care per the company’s policies and procedures.
4. Performs telephonic non-clinical referrals for customers. Performs data entry and timely documents of all calls.
5. Conducts investigation and research to resolve customer inquiries, claims and questions.
6. Performs follow up calls to ensure effective patient care and provision of services. (10%)
7. Communicates actively with internal staff such as Care Managers, Supervisors and other department managers.
8. Use of clinical data is limited to: Performance of review of service request for completeness of information; Collection and transfer of non-clinical data; and Acquisition of structured clinical data; and Activities that do not require evaluation or interpretation of clinical information.
9. Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable.
10. In addition, all other duties assigned by the manager and/or supervisor.
Education:
· Bachelor’s Degree in Behavioral Health or related field preferred.
Experience:
· Minimum 2 years of experience in customer service in a behavioral health or managed care environment preferred.
Knowledge:
· Knowledge and ability to interpret benefit, account and claim information.
· Proficient in data entry.
· Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum.
Read LessEl Profesional de la Salud 1 ofrece servicio al cliente telefónico y resuelve de manera oportuna consultas relacionadas con el cuidado del paciente, elegibilidad, beneficios y reclamaciones, entre otros. Esta persona clave da seguimiento a los pacientes para asegurar la continuidad del cuidado y la eficiencia en la prestación de los servicios. Este empleado no es responsable de realizar actividades de revisión de Manejo Utilización (UM) que requieran interpretación de información clínica.
Verifica la elegibilidad del paciente y coordina citas cuando sea necesario.
Proporciona asistencia verbal y escrita a suscriptores, familiares de pacientes, proveedores, representantes de cuentas, entre otros.
Autoriza el cuidado inicial del paciente conforme a las políticas y procedimientos de la empresa.
Realiza referidos no clínicos por teléfono para los clientes. Registra datos y documenta todas las llamadas de manera oportuna.
Lleva a cabo investigaciones y análisis para resolver consultas, reclamaciones y preguntas de los clientes.
Realiza llamadas de seguimiento para asegurar un cuidado efectivo del paciente y la prestación adecuada de servicios. (10%)
Se comunica activamente con personal interno como Gerentes de Cuidado, Supervisores y otros gerentes de departamento.
El uso de datos clínicos se limita a: revisar solicitudes de servicio para verificar que la información esté completa; recopilar y transferir datos no clínicos; adquirir datos clínicos estructurados; y realizar actividades que no requieran evaluación o interpretación de información clínica.
Cumple con todas las guías establecidas por los Centros de Medicare y Medicaid (CMS) y otras agencias reguladoras aplicables.
Realiza todas las demás tareas asignadas por el gerente y/o supervisor.
Se prefiere Bachillerato en Salud Conductual o campo relacionado.
Se prefieren al menos 2 años de experiencia en servicio al cliente en un entorno de salud conductual o cuidado administrado.
Conocimiento y capacidad para interpretar información de beneficios, cuentas y reclamaciones.
Dominio en entrada de datos.
Experiencia en computadoras personales, incluyendo Microsoft Word, Excel, PowerPoint y Outlook a un nivel intermedio como mínimo.
