Medical, Clinical & VeterinaryClinical Support & Patient Administration
About the job
Requirements
A high school diploma or equivalent is required.
Two years of patient care coordination or patient scheduling experience, or equivalent, is required.
One year of customer service experience is required.
Candidates must be able to work efficiently across multiple engagement channels in a fast-paced contact center environment.
Candidates must be able to learn new processes and workflows quickly.
Candidates must be able to listen to callers while entering data and documenting information accurately.
Candidates must have strong oral and written communication skills and active listening skills.
Candidates must demonstrate a patient and empathetic attitude and interpersonal skills.
Candidates must be computer literate, detail-oriented, and able to learn new software applications and engagement methods.
Candidates must have problem-solving abilities and customer service skills.
Responsibilities
Handle inbound and outbound calls, chat, text messages, and email across multiple lines of business in a professional and efficient manner.
Manage general inquiries, track and remind patients of appointments, and follow processes and procedures while responding sensitively to issues.
Navigate clinic or hospital processes for insurers or utilization review departments by providing clinical information needed to obtain pre-certification for workers’ compensation referrals.
Collect accurate intake data to coordinate care and referrals for occupational health services and workers’ compensation visits.
Assist with and track referrals, appointment scheduling, prior authorizations, and insurance billing verification for tests, procedures, provider appointments, and outpatient rehabilitation services, as applicable.
Assemble information about referral needs to expedite and coordinate care.
Provide referral navigation and care coordination information to appropriate parties according to client referral guidelines.
Stay current on state-specific workers’ compensation and occupational health laws and regulations.
Check eligibility and obtain authorization for ordered services through insurance companies or vendor portals.
Track and reconcile patient referral orders for assigned areas through completion, including return to regular-duty work or maximum medical improvement.
Contact utilization review organizations and insurers, including adjusters and nurse case managers, to confirm prior approval requirements and provide relevant clinical notes, orders, or referrals.
When needed, advocate for patients with carriers to secure timely approval of necessary services.
Use client department service lines and identified providers to coordinate care, and maintain relationships with providers, workers’ compensation adjusters, and nurse case managers.
Ensure referrals are addressed promptly and track referral outcomes.
Communicate with and remind patients, employers, adjusters, and nurse case managers about scheduled appointments.
Meet call-handling, quality-performance, and attendance goals.
Desired Qualifications
Medical Office Administration experience or Medical Assistant Certification is preferred.
Previous occupational health or workers’ compensation experience is preferred.
Electronic medical record experience is a plus.
Bilingual ability is a plus but is not required.
At SCP Health, what you do matters
As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.
Why you will love working here:
- Strong track record of providing excellent work/life balance.
- Comprehensive benefits package and competitive compensation.
- Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect.
RESPONSIBILITIES:
Work efficiently and in a professional manner utilizing multiple forms of engagement (blended inbound/outbound calls, chat, SMS/Text, and email) in a fast paced and challenging contact center environment across multiple lines of business.
Manage general inquiries, track appointments, remind patients of appointments, and follow all processes and procedures while demonstrating sensitivity to any issues.
Serves as a navigator to the clinic/hospital for insurance companies or insurance utilization review department by providing clinical information to obtain pre-certification from payers/adjusters/nurse case managers for workers’ compensation referrals.
Intake accurate collection of data to complete the coordination of care/referral for program service lines (occupational health services and workers compensation visits).
Assist and track referrals/appointment scheduling, prior authorizations, and/or insurance billing verification, when applicable for tests/procedures, including surgical procedures, diagnostic procedures, provider appointments, outpatient rehab services, etc.
Assemble information concerning referral needs to assist with expediting and coordinating care.
Per client referral guidelines, provide information to appropriate parties to assist with referral navigations/care coordination within client’s health system/hospital.
Responsible for staying abreast of state specific worker’s compensation and occupations health laws and regulation.
Check eligibility and obtain authorization for ordered services via insurance companies or acceding vendor portals.
Track and reconcile patient referral orders for assigned areas with follow through to completion, such as return to work regular duty or maximum medical improvements (MMI).
Contact utilization review organizations and insurance companies (adjusters and nurse case managers) to ensure prior approval requirements are met. Present necessary medical information such as clinical notes, orders, and/or referrals for said services.
May assume advocate role on the patient's behalf with the carrier to ensure approval of the necessary services for the patient in a timely fashion.
Utilize client department service lines and identified service providers to coordinate care. Establish and maintain relationships with identified service providers, work comp adjusters and nurse case managers.
Ensure that referrals are addressed in a timely manner and track all referral outcomes.
Communicate and remind patients, employers, adjusters, and nurse case managers of scheduled appointments.
Meet key performance goals including call handling metrics, quality performance, and attendance.
All other duties as assigned.
QUALIFICATIONS:
Education:
High School Diploma or equivalent required
Medical Office Administration experience or Medical Assistant Certification preferred
Certification and Licenses:
Medical Assistant Certification preferred
Previous Experience:
Two years’ patient care coordination or patient scheduling experience or equivalent
One year customer service experience
Previous occupational health, or workers compensation experience preferred
EMR experience a plus
Knowledge Skills and Abilities:
Thrives working in fast based, changing, and growth-oriented environment
Ability to quickly learn new processes and workflows
Ability to listen to caller while entering data and documenting information accurately
Strong communication skills, oral and written
Great active listening skills
Patient and empathetic attitude
Excellent interpersonal skills
Computer literate with attention to detail and the ability to learn new software applications and methods of engagement
Problem solving abilities
Excellent customer service skills
Bilingual a plus but not required
Pay Range:
13.00 - 19.00 USD per hour
This range represents the anticipated base salary for this role. Actual compensation will be determined based on experience, qualifications, and internal equity considerations.
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We offer a comprehensive benefits package designed to support your health, financial well-being, and work-life balance, including medical dental, vision insurance, a 401(k) plan with a company match, paid time off and holidays, professional development support, and employee wellness resources.