Centralized Clinical Support Specialist

Found in: Resume Library US A2 - 2 weeks ago

Georgetown Texas, United States Lone Star Circle of Care Full time
Overview:
The Centralized Clinical Support Specialist (CCSS) is involved in indirect patient care via telephonic and/or other electronic communications, and effectively engaging patients. CCSS assist clinic-based team members in performing verification of insurance benefits, obtaining pre- certifications and pre-authorizations from payers, processing of specialty referral orders from LSCC Providers, patient outreach and appointment scheduling.
Performs duties clerical in nature under direction of Patient Navigation Center Manager in processing referrals and medication prior authorizations to promote coordination of patient care. Under general supervision, makes interpretations and exercises some discretion in routine situations.

 

Responsibilities:
Daily Job Duties:

 

• Obtain, evaluate, and record information in patient record

• Perform outreach to patients using telephonic and/or other communication modes (text, email, mail). Use navigation center web-based call platform when placing outbound calls

• Perform and ensure proper documentation of patient communications and clinical treatment accurately in the use of the Electronic Health Record (EHR) system
• Complete Medication Prior Authorizations as necessary/when applicable

• Perform clinical and non-clinical skills proficiently and in accordance with policies and procedures
• Contact the appropriate health care provider of patient/family concerns, including maintaining a relationship with specialty care providers
• Interact with LSCC healthcare providers to provide optimal care for our patients through electronic
communication (bidirectional tasking in the EHR; recording your outreach work in the EHR’s care coordination template)
• Communicate with external healthcare organizations to obtain the status of patient appointments or referrals
• Take inbound referral orders from providers via HCR reports to assist in coordination of patient care
• As experience and licensure permit and under the direct supervision of team RNs, assist with clinical tasks (performed centrally, at the navigation center, not in clinics) as assigned. May include, but not limited to, responding to task requests from providers, completing prior authorizations, processing referrals, and filing of triage reports, medical records and the mailing of normal lab letters

• Provide initial customer service, including scheduling of patient appointments using an electronic
telephone software system (PureCloud) and an electronic practice management system (NextGen EPM)
as needed
• Perform administrative tasks such as faxing, scanning of documents into the EHR, usage of Medfusion
(patient portal) and activities related to bulk communications (printing of letters and stuffing envelopes
for bulk mailings)
• Process incoming tasks under the Nextgen Provider Letter Group
• Participate in all trainings and refreshers as appropriate
• Participate and collaborate in team meeting

 

Compliance/Customer Service/Training:

• Participate in quality improvement initiatives
• Organize work and utilize time efficiently based on knowledge and procedures
• Assume responsibility for his/her own professional development and for sharing knowledge with others
• Invest own time and effort to improve knowledge, skills and judgment
• Responsible for knowledge and compliance of all LSCC policies and procedure

Qualifications:
REQUIRED EXPERIENCE, EDUCATION, AND LICENSE:

• High School Diploma or GED
• One (1) year experience in a medical office or healthcare setting required

 

PREFERRED EXPERIENCE, EDUCATION, AND LICENSE:

• Medical Assistant (MA) certification or medication experience preferred but not required; salary commensurate with certification
• Bilingual English/Spanish language skills are a definite plus
• Proficiency with MS Office Suite (Word, Excel, and Outlook

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