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**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:

- Processing and tracking referrals and diagnostic orders
- 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
- Having a thorough knowledge of insurance payer and regulatory quality metrics requirements
- Coordinating specialty and diagnostic appointments with patients and specialists/facilities
- Generating and electronically transmitting the summary of care document to the specialist prior to patient appointment for all care transitions
- Communicate to patients their referral responsibilities
- Following up on overdue orders for referrals and diagnostics until results are obtained
- Communicating with community organizations, health plans, outside facilities, and specialists
- 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
- Performing patient reminder calls regarding follow up office visits and services
- Displays effective communication skills with patient populations made vulnerable due to their:

- Financial circumstances
- Place of residence
- Health
- Age
- Personal characteristics
- Functional or developmental status
- Ability to communicate effectively
- 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 m