Children's National Hospital
Sr Clinic Operations Representative - Pain and Allergy Clinics
Children's National Hospital, Washington, District of Columbia, us, 20022
This position reports to the Clinic Operations Manager or Practice Manager. Responsible for ensuring workflow in the clinic, triaging resource issues and involving the supervisor or manager as needed. The role aids the department in meeting financial objectives by providing training and mentoring to other employees both within and outside the department. The position may also need to float to other clinics or ROCS for coverage. It is geared to support a single specialty ambulatory clinic. The next step in the career ladder is Team Lead.
Minimum Education
High School Diploma or GED (Required)
Associate's Degree (Preferred)
Minimum Work Experience 3 years Experience performing billing, patient registration, scheduling, medical insurance verification, insurance screening. (Required)
Required Skills/Knowledge Broad clinic knowledge and customer service skills. Computer knowledge is necessary. Microsoft Office experience is preferred (Word & Excel). Completion of the Ambulatory Services training curriculum and passing all competency assessments, including a mock clinic, are required. The ability to type a minimum of 35 words per minute is also required.
Functional Accountabilities Patient Services
Ensure accuracy of scheduling patients using the applicable scheduling system for the department.
Complete computer‑aided, online 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.
Update scheduling systems with cancellation and no‑shows by COB. Reschedule appointments for patients who did not show or for clinic cancellations by providers. Schedule follow‑up appointments at check‑out if applicable. Able to open and close schedules as needed.
Greet patients and parents courteously. Arrive patients in the appropriate system based on department policy.
Obtain required consents for the department and ensure distribution of compliance related materials (i.e., HIPAA Privacy Notice, Patient Rights). Obtain a copy of the insurance card and photo ID to be stored in the 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.
Collect and record co‑payments, deposits and payments in full and provide payer with receipt. Responsible for helping the department meet 85% of the collection target for the department.
Respond to patient portal work lists (i.e., appointment requests, fax queues, email requests, etc. May include messaging center work lists in the future).
Information Verification
Verify insurance eligibility using the applicable eligibility system. Ensure managed care carve‑outs (lab and radiology carve‑outs) are adhered to.
Notify parents of the need for 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 appointments in a professional & courteous manner.
Counsel parents or refer parent to the 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. The goal is to obtain authorizations 5 days in advance of service; interface with insurance companies as needed; document activity in account notes following standards set by the department.
Utilize all systems where patient information may be stored (EPRS, SCI, Cerner, IDX, McKesson, etc.) to verify that systems are in sync.
Billing Preparation & Daily Reconciliation
Reconcile schedules for upcoming clinic sessions 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.
Review and print clinic schedules, ensure appropriateness of scheduled appointments and back‑fill open slots. Activity should be completed 3‑4 days in advance of clinic session; areas with procedures requiring authorizations work standard may be 5‑7 days.
Verify that families received automated appointment reminder calls and ensure manual confirmations are completed for those that failed the automated messaging. Activity should be completed 3‑4 days in advance of clinic session; areas with procedures requiring authorizations work standard may be 5‑7 days.
Maintain departmental requirements regarding cash controls and deposits. Reconcile daily cash receipts/collections and submit to manager.
Reconcile charge capture against schedules.
Ensures that quality registration work queues are addressed timely. Activity should be completed 3‑4 days in advance of ancillary session; work standard may be 5‑7 days for areas with procedures requiring authorizations.
Performance Improvement, Mentoring and Training
Work with manager to reduce registration and authorization denials.
Work with manager to research and resolve missing charges.
Provide input to manager about registration errors for ongoing training purposes: monitor & correct registration errors; monitor QA reports to identify training needs & ensure standards are met.
Provide expertise to peers throughout the institution: train & mentor P‑AR staff (may conduct training sessions); provide workflow guidance.
Office Support
Answer telephone and address caller needs appropriately. Avoid transferring calls for better service to families. Meet department standards relative to ACD policies if applicable. Manage voicemail messages within the same business day.
Distribute mail. May work returned mail as needed.
All staff are responsible for information distributed via e‑mail. Staff should check work email a minimum of three times daily and respond to inquiries within 24 hours (or next business day).
Maintain office files and office supplies at P‑AR levels.
Maintain clean reception area and workspace.
Other support as needed.
Organizational Accountabilities Organizational Commitment/Identification
Anticipate and respond to customer needs; follows up until needs are met.
Teamwork/Communication
Demonstrate collaborative and respectful behavior.
Partner with all team members to achieve goals.
Receptive to others’ ideas and opinions.
Performance Improvement/Problem‑solving
Contribute to a positive work environment.
Demonstrate flexibility and willingness to change.
Identify opportunities to improve clinical and administrative processes.
Make appropriate decisions, using sound judgment.
Cost Management/Financial Responsibility
Use resources efficiently.
Search for less costly ways of doing things.
Safety
Speak up when team members appear to exhibit unsafe behavior or performance.
Continuously validate and verify information needed for decision making or documentation.
Stop in the face of uncertainty and take time to resolve the situation.
Demonstrate accurate, clear and timely verbal and written communication.
Actively promote safety for patients, families, visitors and co‑workers.
Attend carefully to important details—practicing STOP, THINK, ACT and REVIEW in order to self‑check behavior and performance.
#J-18808-Ljbffr
Minimum Education
High School Diploma or GED (Required)
Associate's Degree (Preferred)
Minimum Work Experience 3 years Experience performing billing, patient registration, scheduling, medical insurance verification, insurance screening. (Required)
Required Skills/Knowledge Broad clinic knowledge and customer service skills. Computer knowledge is necessary. Microsoft Office experience is preferred (Word & Excel). Completion of the Ambulatory Services training curriculum and passing all competency assessments, including a mock clinic, are required. The ability to type a minimum of 35 words per minute is also required.
Functional Accountabilities Patient Services
Ensure accuracy of scheduling patients using the applicable scheduling system for the department.
Complete computer‑aided, online 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.
Update scheduling systems with cancellation and no‑shows by COB. Reschedule appointments for patients who did not show or for clinic cancellations by providers. Schedule follow‑up appointments at check‑out if applicable. Able to open and close schedules as needed.
Greet patients and parents courteously. Arrive patients in the appropriate system based on department policy.
Obtain required consents for the department and ensure distribution of compliance related materials (i.e., HIPAA Privacy Notice, Patient Rights). Obtain a copy of the insurance card and photo ID to be stored in the 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.
Collect and record co‑payments, deposits and payments in full and provide payer with receipt. Responsible for helping the department meet 85% of the collection target for the department.
Respond to patient portal work lists (i.e., appointment requests, fax queues, email requests, etc. May include messaging center work lists in the future).
Information Verification
Verify insurance eligibility using the applicable eligibility system. Ensure managed care carve‑outs (lab and radiology carve‑outs) are adhered to.
Notify parents of the need for 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 appointments in a professional & courteous manner.
Counsel parents or refer parent to the 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. The goal is to obtain authorizations 5 days in advance of service; interface with insurance companies as needed; document activity in account notes following standards set by the department.
Utilize all systems where patient information may be stored (EPRS, SCI, Cerner, IDX, McKesson, etc.) to verify that systems are in sync.
Billing Preparation & Daily Reconciliation
Reconcile schedules for upcoming clinic sessions 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.
Review and print clinic schedules, ensure appropriateness of scheduled appointments and back‑fill open slots. Activity should be completed 3‑4 days in advance of clinic session; areas with procedures requiring authorizations work standard may be 5‑7 days.
Verify that families received automated appointment reminder calls and ensure manual confirmations are completed for those that failed the automated messaging. Activity should be completed 3‑4 days in advance of clinic session; areas with procedures requiring authorizations work standard may be 5‑7 days.
Maintain departmental requirements regarding cash controls and deposits. Reconcile daily cash receipts/collections and submit to manager.
Reconcile charge capture against schedules.
Ensures that quality registration work queues are addressed timely. Activity should be completed 3‑4 days in advance of ancillary session; work standard may be 5‑7 days for areas with procedures requiring authorizations.
Performance Improvement, Mentoring and Training
Work with manager to reduce registration and authorization denials.
Work with manager to research and resolve missing charges.
Provide input to manager about registration errors for ongoing training purposes: monitor & correct registration errors; monitor QA reports to identify training needs & ensure standards are met.
Provide expertise to peers throughout the institution: train & mentor P‑AR staff (may conduct training sessions); provide workflow guidance.
Office Support
Answer telephone and address caller needs appropriately. Avoid transferring calls for better service to families. Meet department standards relative to ACD policies if applicable. Manage voicemail messages within the same business day.
Distribute mail. May work returned mail as needed.
All staff are responsible for information distributed via e‑mail. Staff should check work email a minimum of three times daily and respond to inquiries within 24 hours (or next business day).
Maintain office files and office supplies at P‑AR levels.
Maintain clean reception area and workspace.
Other support as needed.
Organizational Accountabilities Organizational Commitment/Identification
Anticipate and respond to customer needs; follows up until needs are met.
Teamwork/Communication
Demonstrate collaborative and respectful behavior.
Partner with all team members to achieve goals.
Receptive to others’ ideas and opinions.
Performance Improvement/Problem‑solving
Contribute to a positive work environment.
Demonstrate flexibility and willingness to change.
Identify opportunities to improve clinical and administrative processes.
Make appropriate decisions, using sound judgment.
Cost Management/Financial Responsibility
Use resources efficiently.
Search for less costly ways of doing things.
Safety
Speak up when team members appear to exhibit unsafe behavior or performance.
Continuously validate and verify information needed for decision making or documentation.
Stop in the face of uncertainty and take time to resolve the situation.
Demonstrate accurate, clear and timely verbal and written communication.
Actively promote safety for patients, families, visitors and co‑workers.
Attend carefully to important details—practicing STOP, THINK, ACT and REVIEW in order to self‑check behavior and performance.
#J-18808-Ljbffr