Clinic Assistant I, II, III, IV, V

Job Summary

Required Qualifications

• •HIPAA policies and procedures
• •eClinical Works (eCW)
• •Front Desk responsibilities
• •Appointment Scheduling responsibilities
• •Pre-Certification responsibilities
• •Referral responsibilities
• •Medical Assistant Back Office Support responsibilities
• •Maintain confidentiality of patient's private protected medical information
• •Maintain current demographics and insurance information
• •Review any eligibility issues on all patients prior to visit
• •Master the ability to identify and assign correct insurance on patient accounts including subscriber information required for proper billing
• •Establish Competency eClinical Works (eCW) Check Off Learning Modules
• •Master eCW Workflow to Check Out patients, Schedule New & Recheck, Print Patient Summaries, Labs, Appt. Reminders, and Patient Instructions
• •Initiate and Update HIPAA Forms
• •Run Self Pay Checklist and Medicaid Eligibility
• •Perform opening and Closing Reception Service duties
• •Coordinate with the Triage Nurse
• •Answer all incoming calls in a professional, courteous, and efficient manner
• •Schedule appointments according to NH policy and protocols
• •Run eligibility inquiry on all patients prior to scheduling
• •Take detailed messages via email from caller when voicemail is not an option
• •Initiate calls to patients to reschedule or fill gaps
• •Work in coordination with the Health Care Workers
• •Obtains precertification, prior approval, or pre-determination authorization for medications, procedures/tests, services, medical supplies and durable medical equipment ordered by physician
• •Contacts patient's insurance company, including workman's compensation carriers, for eligibility, pre-existing, or exclusions
• •Determines if prior approval is needed and notifies the appropriate department staff of outcome
• •Contact patient to resolve any issues that occur during the verification process prior to their visit
• •Assists in answering patient questions when they present regarding insurance coverage for a procedure
• •Documents in the computer system the precertification, prior approval or pre-determination authorization information from the insurance company
• •Merge lab results
• •Daily checks the schedule for possible add on patients that had not been previously approved through the precertification, prior approval, or predetermination process
• •Obtain records for patient encounters
• •Interacts with physicians, nurses, coders, and other Clinic staff to gather patient information needed for precertification, prior approval, or pre-determination process
• •Prioritize urgent requests
• •Obtain a retrospective review on those services where prior authorizations were not obtained
• •Document in eCW all information provided by the insurance representative
• •Document completion of tasks in eCW
• •Notify patient when authorization has been obtained/denied
• •Notify pharmacies, hospitals, DME providers, and vendors when authorization has been obtained/denied
• •Communicate any changes in pre-certification requirements to relevant staff
• •Collaborate with staff on referral needs and payer requirements
• •Seeks guidance from licensed staff when needed
• •Run eligibility reports on all patients
• •Participates in contacting patients prior to office visits to ensure appropriate information is on chart and to clarify reason for appointment
• •Tracks On Call to ensure patients are getting timely medical advice while clinic is closed
• •Checks recent ER patients through hospital system, determine if they are patients and if so, contact for follow up
• •Schedule referral appointments for testing, specialty physicians, outpatient needs, and any other scheduling as determined by the physician during the office visit
• •Track referrals, labs, and radiology reports
• •Schedule for PT, OT, Speech Therapy, Home Health, or Dietitian/Nutritionist
• •Performs basic clerical duties including photocopying, sorting and filing of reports
• •Updates patient demographics if inaccuracies are found
• •Inspect patient's EMR to ensure completeness prior to appointment
• •Escort patient to exam room, interviews patient, measures vital signs such as weight, blood pressure, pulse, temperature, and documents all information in patient's chart within required timeframe
• •Assist physician in exam room as needed
• •Provide instructions to patient as instructed by physician
• •Ensure all related reports, labs, and information is filed and available in patient's medical records prior to appointment
• •Keep exam rooms stocked with adequate medical supplies, maintain instruments, prepare sterilization as required
• •Anticipates physician's needs, prepares patient appropriately for appointment
• •Tracks All Call to ensure patients are getting timely medical advice while clinic is closed
• •Assist with scheduling referral appointments for testing, specialty physicians, outpatient needs, and any other scheduling as determined by the physician
• •Assist with resulting labs as designated by Clinical Leadership Team
• •Maintains current information and knowledge base