Referral Coordinator / Medical Assistant / Infusion Intake / HIM at Streng Bassi Begum and Jiang Medical Corporation – Claremont, California

The Referral Coordinator / Medical Assistant/ Infusion Intake/ HIM Coordinator is an important position that is responsible for: Submitting Referral requests and obtaining authorizations for the practice to ensure requested services are approved; Performing intake verification of insurance, including obtaining all pre-certifications/authorizations for in–office antibiotic infusion therapy, and scheduling infusion patient appointments; Medical Assistance to the Registered Nurses and Physicians, primarily in our Infusion Center; Basic clerical tasks such as answering phones, greeting patients and visitors.

This position performs a wide variety of duties and responsibilities in a manner that places emphasis on quality of care and customer service. The incumbent must work collaboratively with all Clinical services staff in support of direct patient services, exhibiting flexibility and a “can-do” attitude. Patient services are the key priority in this position requiring them to serve as a point of contact with other internal and external departments, all with the goal of fostering an environment which promotes patient comfort and trust. The position must exemplify the core values and mission of the organization, always exercising utmost discretion, diplomacy and tact in patient/staff interactions.

Job Duties: Referral Coordinator

• Requires a solid understanding of insurance procedures and a working knowledge of medical terminology and coding.
• Acting as a liaison between insurance and healthcare providers to ensure required referrals have been processed correctly for medical specialty services, including Specialty Radiology Studies, PICC line insertions, Home Health Services, referrals to other Specialty Providers, etc. (This does not include Prescription Prior Authorizations.)
• Filing documents, keeping records and performing other clerical duties as assigned
• Requires a high level of analytical skills work with the complex medical and social needs for patients/families.
• Must possess an understanding of private, managed care and public health plans as well as other local, state, or federal coverage programs
• Able to verify eligibilities and benefits for all patients and payers.
• Ensures all chart notes, referral information and required documentation is complete and submitted to the referral entity in a timely manner.
• Ability to efficiently utilize all authorization portals with ease.
• Provide constant review of submitted authorizations, to efficiently manage status of approvals and/or denials.
• Maintain chronological Referral Log, with patient names, DOB’s, requested services, Payer info, submission dates, status updates, approval/denial dates, and patient notification dates.
• Consistently communicate updates and authorization approvals with Patients.
• Assist in scheduling specialty services-(CT’s, MRI’s, PICC insertions, etc.), on behalf of patient.

Job Duties: Infusion Intake

• Maintains confidentiality of all information received via fax, mail or telephone. This includes ensuring all PHI remains consistently protected on computers and hard copy documents are out of plain site.
• Welcomes and greets all patients and visitors, in person or over the telephone.
• Answers the phone while maintaining a polite, consistent phone manner using a proper and professional telephone etiquette.
• Responsible for keeping the reception are clean and organized at all times.
• Registers new patients and updates existing patient demographics by collecting detailed patient information, including personal and financial information and Insurance cards and ID. Also requests supporting medical records from referring physician’s offices.
• Facilitates patient flow by notifying the Infusion Clinical Staff of patient’s arrival. Also communicates any unforeseen delays to patients and Clinical Staff.
• Explains the Clinic policies and documentation to patients to confirm a complete understanding of what to expect.
• Maintain exceptional communications with Vendors.
• Provide assistance in Infusion Center oversight. Patient concerns, safety issues, etc.
• Guarantee Insurance Verifications and pre-certifications are performed on every patient referred to Infusion, prior to any services being performed. This includes obtaining detailed authorizations for all managed care payers, with precise quantities and appropriate CPT codes.
• Communicate expediently with Physicians to inform of any issues preventing the service from going forward. This can include non-covered benefits, Auth required which would delay patient care, negative financial impact on practice, high cost patient responsibility, etc.
• Providing support to medical billing staff. Must have a basic understanding of ICD-10 and CPT coding.

Job Duties: Medical Assistant

• Maintains cleanliness of Infusion Center according to strict protocols and compliance with infection control standards
• Ensures all necessary supplies are stocked. Promptly reports when supplies are low and works with nursing staff and management to ensure timely reordering is completed.
• Appropriately prepares patient for visit and alerts Registered Nurse when patient is ready to be receive therapy.
• Greets patients and directs to appropriate Infusion Chair. Provides initial medical screening and obtains daily patient vital signs-(weight, height, temp, blood pressure, and brief update on patients condition, including any recent set-backs or complications. Accurately documents and communicates patient details with Nurse, according to generally accepted medical standards. Practices universal precautions with respect to established safety protocols. Facilitates communication between the provider(s) and patient as needed, including translation as appropriate.
• Utilizes time in a constructive and efficient manner by assisting in such duties as restocking/shelves/trays, checking supplies and ensuring that all areas, of the Infusion Center are clean and orderly.
• Sets up all scheduled patient medications for following day, with appropriate labeling, inventory management of all drugs on hand, maintains meticulous patient orders and Infusion calendars and communicates to Manager what medications should be ordered to service the anticipated patients for the following week.
• Performs general clerical duties in support of patient services according to the needs of the clinic. These include but are not limited to answering phones, electronic faxing, typing, etc. Works with Practice Management system to assist with Patient Registration
• Accepts floating assignments to other areas of Clinical (Infectious Disease), as needed and assigned.
• Maintains nurses' station and Medication Room, according to protocols. Performs routine quality check of equipment and promptly reports damaged or missing equipment.
• Ensures clinical areas are organized with respect of standards in safety and quality patient care. Works collaboratively with all Clinical staff and other departments in solutions-oriented problem solving with the goal of providing quality patient care.
• For safety and security reasons, the MA is responsible for knowing the whereabouts of a patient any time the patient is in the Infusion Center. In the event a patient or clinic emergency, the MA may be called to activate the proper ‘code’, assisting provider(s) and clinical staff with the appropriate emergency response. In the event of evacuation, the MA will assist in the evacuating of patients being seen by her/his provider(s) as scheduled.
• Attends staff and medical meetings, as required.
• Acts in capacity as interpreter, as needed.
• Performs all duties and service in full compliance with FIDMGI’s Service Excellence Standards.
• Performs additional duties, as assigned by RN, MD and Practice Manager and in support of exceptional patient care, quality assurance, and improvement.

Job Duties: Health Information Management

• Manages, records and processes requests for Medical Records, including HEDIS or Health Plan Chart Audits, Subpoenas Physician office requests and patient requests
• Ensures that all MR’s are sent to requestor in a timely manner
• Collects appropriate fees associated with Medical Record requests
• Maintains meticulous MR requests and the disposition of requests.

General Qualifications

• Strong experience and knowledge on submitting and managing referrals and authorizations
• Excellent communication skills at level necessary for taking patients' medical histories, understanding provider and supervisors instructions, and for accurately documenting patients' medical information. Ability to effectively communicate with patient population and staff while demonstrating a high degree of diplomacy and tact.
• Intermediate computing and phone skills.
• Willingness to work evenings and/or weekends; demonstrates flexibility in regards to job duties and assignments.
• Ability to multi-task and work effectively in a high-stress and fast-moving environment.
• Culturally sensitive and demonstrated ability and effectiveness working with ethnically diverse populations.
• Working knowledge of “Universal Precautions,” demonstrates professionalism at all times.
• Possess a thorough understanding of the importance of confidentiality and non-disclosure according to the general standards set forth by HIPAA.
• Bilingual English/Spanish required.

Education:

High School diploma or graduation equivalency degree (GED). Knowledge of clinical procedures usually obtained from a certificate or Associates degree in a clinical program including anatomy, physiology, phlebotomy, first aid and medical terminology. Knowledge of office procedures usually obtained from a certificate or Associates degree in a business program including administrative processes and procedures, claims processing, preparing and documenting in patient charts and intermediate computer skills.

Experience/Skills:

Experience: Entry level, previous office administration or referral coordination/receptionist and Medical Assistant experience and a minimum of two years work experience in a medical office setting.

Skills: Telephone etiquette, Exemplary Customer Service, basic word and excel knowledge, time management, multi-tasking, organization, scheduling, and computer literate.