GENERAL JOB DESCRIPTION : Oversees and coordinates all clinical care outside of the clinic office visit to provide concierge customer service while ensuring that quality and patient safety expectations are met. Coordinate and communicate timely with patients, providers, and third parties on all incoming inquiries as well as following up on action items throughout the patient’s recovery. Providing coverage as needed across department.

Essential Functions

Responsible for receiving, documenting, and handling in-coming calls. Schedule surgeries, MRI’s, CT scans, Myelograms, Epidurals, etc., including pre-op, follow-up and initial PT appointments at appropriate facilities. Complete surgery checklist with appropriate information & knowledge of each physician’s schedule and surgery guidelines.
Submits medical records, works with the provider on necessary documentation, if necessary, to obtain pre-authorization as needed.
Consults with the appropriate provider to obtain clearance that treatment regimen is considered medically necessary before initiating request to the insurance plan.
Closely monitors the authorization process and keeps physician and patient updated as needed.
Documents accurately in the electronic medical record all necessary authorization numbers and effective dates for the episode of care.
Schedules Peer-to-Peer calls when necessary.
Assist with obtaining prior-auth including eligibility verification and an estimate for what the patient is expected to pay.
Issues prescriptions, physical therapy orders, home exercises, work restrictions, and other orders per physician instruction and assists in patient education.
Assist with ensuring all medication requests received before 4 p.m. and all patient cases are responded to on the same business day. If an answer cannot be obtained, the patient is notified that their question will be addressed the next business day. Facilitate capture of patients’ opioid history for physician review.
Queue lab results into system through EMR interface.
Schedules appointments for patients when needed.
Reviews assigned physician’s surgery schedule in advance for quality assurance and make corrections as needed. Work with the Surgery Coordinator/Triage Team Lead and Office Manager to coordinate training of physician’s preferences.
Responsible for tracking all adverse events such as post-operative complications and hospital readmissions accordingly.
Facilitate the capture of patient reported outcomes through appropriate platform.
Monitors assigned voicemail and returns calls same day.
Maintains all information in the strictest confidentiality.
Provides coverage for peers when assigned.
Some travel to other locations required.
All other duties as assigned.

Qualifications

Education :

High school diploma or GED

Experience

Two years as a medical assistant with hospital, home health, or office experience; preferably orthopedics related
Two years of surgery scheduling preferred

Licensure

Current Medical Assistant certification (CMA) preferred

Special Skills

Knowledge of computer systems and applications
Knowledge of medical terminology
Pharmaceutical knowledge
Ability to work in a fast paced environment
Attention to detail
Excellent problem solving skills

Physical Demands

Ability to sit for extended periods of time
Ability to lift and carry items weighing up to 50 pounds.
Must have full range of motion.
Must have adequate visual acuity to read, the ability to interpret and understand written material.
Must have adequate hearing and speaking abilities to interact appropriately with others, including patients and co-workers.

Environmental Working Conditions

Combination clinic and office setting.
Travel between clinic locations.
Exposure to communicable diseases, toxic substances, radiation and bodily fluids.

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