HIM Specialist

SUMMARY

Under the direct supervision of the Practice Administrator, the Health Information Management (HIM) Specialist is responsible for general clerical duties with in the HIM department; duties include but are not limited to typing, scanning, filing, computer input and telephone communications with patients, insurance companies, outside facilities and specialists.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Enter correct and accurate information into the electronic medical record and practice management system including patient demographics, insurance information, and medical histories
• Answer phones quickly (by second ring) and courteously, using approved telephone techniques and etiquette.
• Telephone skills must be exceptional.
• Messages for physicians and other staff should be accurately typed in to patient’s electronic medical record and sent via task message to the appropriate person.
• Communicate with patients, provider offices, hospitals, and insurance companies using exceptional customer service
• Facilitates the coordination of care for individual patients by:

1. Processing and tracking referrals and diagnostic orders
2. Obtaining insurance authorization as appropriate in a timely and thorough manner to maximize quality patient care, with knowledge of insurance benefits, in/out of network requirements, pre-determination services, and medical necessity; tracking authorizations and maintaining status and outcome of requests
3. Having a thorough knowledge of insurance payer and regulatory quality metrics requirements
4. Coordinating specialty and diagnostic appointments with patients and specialists/facilities
5. Generating and electronically transmitting the summary of care document to the specialist prior to patient appointment for all care transitions
6. Communicate to patients their referral responsibilities
7. Following up on overdue orders for referrals and diagnostics until results are obtained
8. Communicating with community organizations, health plans, outside facilities, and specialists
9. Preparing the patient chart prior to patient office visits by completing pre-visit planning: following up on overdue orders, and noting care gaps, medications needing refills and suspected problems/diagnosis codes
10. Performing patient reminder calls regarding follow up office visits and services

• Displays effective communication skills with patient populations made vulnerable due to their:

1. Financial circumstances
2. Place of residence
3. Health
4. Age
5. Personal characteristics
6. Functional or developmental status
7. Ability to communicate effectively
8. Presence of chronic illness or disability

• Knowledge of Health Information Exchange
• Maintains concise documentation in patients’ electronic medical records
• Scans and files documentation correctly into patients’ electronic medical records and updates appropriate care guidelines for tracking/performance reporting, including electronic faxes and unmatched interface records in Rosetta Holding Tank
• Perform clerical duties (e.g., photocopying, typing, forms, mailing, faxing, etc.)
• Knowledge of the case management process
• Adheres to team-based approach in patient care
• Adheres to patient-centered medical home policies and procedures in conjunction with NCQA guidelines
• Attends mandatory staff meetings and huddles
• Maintain confidentiality of patient data at all times
• Other duties as assigned (responsibilities and procedures may be further described in a Policies and Procedures Manual).

SUPERVISORY RESPONSIBILITIES

This job has no supervisory responsibilities.

MONTAGE VALUES

Employees of Montage Medical Group are expected to uphold the Montage Values and Service Standards. Montage Medical Group employees find joy in caring for those we service, are dedicated to coordinating care across all settings, take ownership, collaborate to deliver the highest quality care and are entrusted to serve our community with respect

QUALIFICATIONS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION and/or EXPERIENCE

High school diploma or general education degree (“GED”); and at least three months (preferably six months) related experience (e.g., health care setting, customer service, etc.) and/or training; or equivalent combination of education and experience.

Experience with medical terminology (e.g., CPT and ICD9 codes) and understanding of medical insurance process preferred and extremely helpful. Must understand or quickly learn about the differences between and among self-pay patients, insured patients, Medicare and Medicaid patients, workers’ compensation patients, and occupational medicine patients.

Must respond courteously, sympathetically and maturely to patient needs. Must be neat and professional in appearance. Detail oriented and well organized. Computer literate (i.e., be familiar with a PC and basic software, such as Microsoft Windows, Microsoft Word, etc.) Bilingual may be required. Must be able to work under pressure and in stressful situations and must be able to work quickly when business conditions warrant.

PATIENT SERVICE, ATTITUDE AND LANGUAGE SKILLS

The employee performing this position is expected to have superior patient service, speaking skills and a professional attitude. One of Montage Medical Group’s core values is we are a “Patient-Centered” practice. High patient satisfaction and whole-person care are of critical importance and all employees must strive to achieve 100% patient satisfaction and quality outcomes for all patients. All communications to co-workers, patients and clients must be courteous (e.g., “Mr. Smith, the Medical Assistant will show you to one of the exam rooms now.”)

The employee performing this position is expected to be able to speak clearly and effectively communicate with patients and co-workers. The employee must respect, understand and observe the importance of patient confidentiality. He/she is expected to abide by the company’s HIPAA privacy policy.

MATHEMATICAL, FINANCIAL SKILLS AND COMPUTER SKILLS

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to handle cash transactions and “reconcile” cash drawer balances with computer system reports.

Ability to effectively and efficiently use a computer and related business and medical software. Ability to use typical business equipment, such as fax machine, photocopier, adding machine, business telephone, voicemail, e-mail. The employee must be able to master the electronic medical record and practice management computer system for purposes of patient registration, scheduling, payment entry and certain other tasks. Errors must be kept to a minimum (e.g., management occasionally runs error-checking reports, and receptionists may not erroneously miss entering patient social security numbers on more than 5% of the accounts that they register). Type 30+ WPM.

REASONING ABILITY

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

CERTIFICATES, LICENSES, REGISTRATIONS None.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to stand; walk; climb or balance; and stoop, kneel, crouch, or crawl. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, color vision, and ability to adjust focus.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is occasionally exposed to moving mechanical parts (medical and office equipment), risk of working with blood borne pathogens, and risk of radiation (from x-ray units or office equipment such as computer monitors). The noise level in the work environment is usually moderate.

A medical group can be a stressful and high-pressure environment. Individuals must enjoy working in such environments and be willing to adapt the pace of their work and output to the patient volumes and tasks of a medical facility.