Coordinates the encounter or episode process for our patients and consumers by performing activities related to patient scheduling. Accuracy in scheduling is paramount in performance. Responsible for providing excellent patient experience. Illustrate insurance contract requirement knowledge and use of tools to respond to provider network questions. Secure prior authorization or referral in applicable situations. Use on-line tools to validate eligibility of coverage for presenting patients. Provides comfort rounding and communicates delays with exceptional patient experience tools. Other duties as assigned.
Type of Opportunity: Full time
Job Exempt: No
Job is based: Presbyterian Rust Medical Center
Work Shift: Weekday Schedule Monday-Friday (United States of America)
Customer Service and Caring Practices: Achieve exceptional patient experience for patients and patient families by using CARES, AIDET and EPE tools. Addresses and attempts to appropriately resolve complaints in the moment by using key words at key times. Ability to manage conflict and appropriately request the help of a supervisor when needed. Round with patients waiting to insure their comfort and to inform of delays when applicable
Encounter Components: Performs the patient scheduling process and validating accurate patient demographics. Guide informed dialogue with patients and patients representatives regarding in-network coverages (respecting CDS and RDS guidelines). Set patient expectations regarding Prior Authorization, Referrals and out of pocket expenses
Financial Accountabilities: Refers as appropriate to on site Financial Advocate, or for uninsured to the Financial Advocacy Center
Message Management: Formulates complete and accurate telephone encounter messages and routes to the appropriate Epic in-basket pool to support operational aspects of patient care
Medical Record Components: Instructs patients on the Release of Information process and insure a fully completed ROI Form is submitted to Health Information Management for incoming or outgoing records
Patient Relations: Comprehend quality service connection to patient satisfaction and reimbursement. Participate in metric goals for telephones performance metrics, TSF and abandonment rate. Perform confirmation calls when applicable to include directions and instructions as required by the visit type
Patient Safety: Respond quickly to patients showing distress. Follow guidelines set forth by the Clinic Manager to alert the clinical team. Assist in any manner the clinic team directs. Ensure scheduling area/office, waiting area and walkways are clear of any unnecessary items and are clean and neat. Report any concern that may create a safety issue. Annual competency completion of Clerical Staff during a Code Blue
Quality Improvement: Perform assigned patient care responsibilities, which may include: Appointment reminder calls Rescheduling Evaluate provider schedules and take appropriate action to ensure accuracy and efficiency per guidelines
C.A.R.E.S Behaviors: Demonstrates CARES behaviors of Collaborate, be Accountable, Respect, Engage and Serve to all whom you encounter.
Academic Preparation: High school or equivalent
Experience: A minimum of nine (9) months of work experiences in office, healthcare or customer service environment is required. Must pass EPIC competency for Registration at completion of Epic Clerical Training class.
Abilities: Performs appointment scheduling for patient via the telephone or in person to include testing, procedures and clinician appointments. Coordinates advanced scheduling visit types to include physicians, APCs, resources and technicians. Pass annual competency exam for all areas of responsibility. Attend Quarterly MSO meetings. Attend Staff meetings. Attend Employee Forums
All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
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