Client Services Operations Specialist

2 weeks ago

Fort Myers, Florida, United States American Oncology Management Company Full time

Position Title: Client Services Operations Specialist

Location: Remote

Compensation: $27.86 per hour

Role Overview:

Under the guidance of the Client Services Manager, the Client Services Operations Specialist will be responsible for reviewing, updating, and maintaining established operational standards to enhance productivity within the revenue cycle and client services. This role may involve assisting with the accessioning process for clinical and pathology testing.

The specialist will handle incoming communications, including calls and emails, and manage all third-party testing requirements while performing additional tasks as directed by the Client Services Manager.

The Client Services Operations Specialist will collaborate with the Accessioning Supervisor and Client Services Manager to allocate work assignments, ensuring adequate coverage and delegation as necessary. This position acts as a liaison among the business office, clinic, and laboratory to address all internal and external customer service needs effectively.

Responsibilities include reviewing medical insurance policies for incoming shipments and utilizing the Insurance Matrix and Provider Billing Report to ensure accurate test routing for both in-house testing and external send-outs. The specialist will work closely with the Utilization Management (UM) team to secure authorizations for in-house pathology testing when required and assist the revenue cycle team in analyzing various BI reports, addressing denials, and managing claims resubmissions as needed.

Key Responsibilities:

Clinical and Laboratory Support:

  • Manage all customer inquiries received via telephone, fax, and email regarding patient results, test inquiries, service concerns, and other duties to provide superior service.
  • Report laboratory results to providers following established protocols.
  • Document all reporting and call history accurately and maintain comprehensive records.
  • Assist in resolving routine issues related to patient testing and result reporting.
  • Report client concerns using established protocols.
  • Provide education and updates regarding laboratory processes.
  • Understand the significance of Quality Service and its measurement.
  • Perform additional duties as required to meet customer needs.
  • Assist with accessioning tasks as needed and maintain proper training for accessioning responsibilities.

Analysis and Reporting:

  • Ensure all executed authorizations and insurance verifications are received, scanned, and documented in the EMR, with the billing database updated accordingly.
  • Extract scheduling reports to review routing, authorization requirements, and follow up on changes to shipping and ordering.

Auditing:

  • Prepare and review test routing and volume reports on a monthly basis.
  • Prepare and review denial reports monthly.
  • Maintain in-house testing menus and clinic contact lists.
  • Review in-house and send-out cases to ensure turnaround times meet standard procedures.

Billing:

  • Assist with claims processing to ensure appropriate laboratory reports are uploaded into the EMR.
  • Review pathology cases for correct diagnosis codes and update as necessary.
  • Review clinical billing to ensure appropriate diagnosis codes are utilized according to guidelines.
  • Act as a liaison between the laboratory, clinic, and reference laboratories to ensure timely claims processing by addressing problem holds.
  • Screen test orders to confirm proper authorization is on file and that compatible diagnosis codes are used for processing.
  • Submit billing for specific tests and upload results into the EMR.
Qualifications:

Education: High School Diploma required; Bachelor's Degree preferred.

Experience:

  • 1-2 years in a medical billing and/or laboratory environment.
  • Experience in a medical and/or laboratory setting with a solid understanding of medical/laboratory terminology.
  • 1-2 years' experience with insurance authorization and benefit investigation preferred. Candidates pursuing a Bachelor of Science Degree in Biology, Chemistry, Molecular Biology, or a related field are desirable.
  • Demonstrated dependability, flexibility, and adaptability in all aspects of laboratory responsibilities and scheduling.

Certifications/Licenses:

  • Preferred certifications include CCA (Certified Coding Associate), CCS (Certified Coding Specialist), or CPC (Certified Professional Coder).

Core Competencies:

  • Analytical & Critical Thinking: Strong problem-solving, analysis, decision-making, planning, time management, and organizational skills.
  • Interpersonal Skills: Developed interpersonal skills, emotional intelligence, diplomacy, tact, and conflict management abilities.
  • Communication Skills: Proficient in English with effective oral, written, and presentation skills.
  • Customer Service Orientation: Strong focus on customer satisfaction and quality service.
  • Self-Management: Ability to manage time effectively and work independently with minimal supervision.

Computer Skills:

  • Proficiency in MS Office Suite (Word, Excel, PowerPoint, Outlook) is required.

Travel: No travel required.

Standard Work Hours: Monday to Friday, 30-40 hours per week.

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