Clinical Support Specialist
Company: Community Health Program Inc
Location: Great Barrington
Posted on: May 12, 2022
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Job Description:
ABOUT THE ORGANIZATIONCommunity Health Programs is a network of
health centers and caring professionals that provide outstanding
primary and preventive care for patients of all ages. What's truly
unique to CHP is our broad spectrum of support services that extend
beyond medical and dental issues to strengthen families and improve
children's well-being. The region is a federally designated rural
community and a Medically Underserved Population Area. Community
Health Programs embraces its role as a nonprofit health care
provider and community partner. We are a leader in the communities
we serve by providing high quality healthcare, dental services,
wellness education and family support services. CHP outreach
provides free health screenings, insurance enrollment assistance as
well as information so people can learn how to take better care of
themselves and their families.DescriptionThe Clinical Support
Specialist (CSS) is a valuable member of the clinical support team
that is collectively responsible for servicing all aspects of the
prior authorization process, the tracking and maintenance of the
medical records under all HIPAA rules, and coordinating referrals
as directed by CHP clinicians on a patient's behalf. The clinical
support team serves each CHP site equally. Manages relationship
between patient and health center, with various insurance
companies, to ensure compliance with referral and authorization
requirements. S/he is responsible for monitoring physical and
electronic faxes and incoming documentation, including various
items found in the Athena Clinical Inbox ("buckets"). The CSS will
support CHP's mission, vision, and values, and will adhere to
compliance protocols as well as CHP's policies and
procedures.POSITION REQUIREMENTSClinical Support Specialist
Essential Duties and Responsibilities: Medical Records: Files all
medical information either by scanning or bar coding into patient
charts in timely manner. Responds to requests for files from
providers. Sends/receives files from other providers as requested,
always following HIPAA protocols. Performs clerical duties as
requested pertaining to medical record releases. Documenting fax
and invoice status of records in Athena. Barcode and scan documents
into Athena. Generate invoices and track payments for records.
Prior Authorizations: Efficiently obtain all authorizations for
procedures to be performed, prior to patients scheduled date of
service. Notify scheduling staff of delays in obtaining required
authorizations. Inform supervisor about any changes or patterns
they are seeing in denials of procedures. Accept, handle, and
process incoming patient telephone inquiries using appropriate
customer service skills, clarify and validate patient inquiries,
questions or complaints and correct and update patient account
information in the computer system. Referrals: Coordinates all
outgoing/incoming referrals: Maintains the computerized managed
care system log and maintains electronic referrals in EMR.
Schedules all referral appointments and documents this information
on the referral request form and practice management system, and
notifies patient of same. Collaborates with the primary care
provider to resolve issues related to specialist availability and
patient needs. Files all completed referral forms in the patient's
chart. Maintains a system for easy access to authorization numbers,
number of visits, and utilization. Completes follow-up with
hospitals with regard to submitting orders and any other related
documentation (financial or clinical). Functions as a resource of
information and problem solving for patients, primary care
providers, managed care program staff, specialists and health
center staff. Maintains up-to-date knowledge of insurance company
requirements, communicating changes to colleagues and peers.
Assists with development and presentation of managed care reporting
on monthly basis, including but not limited to: indicating numbers
of referrals, turnaround time for booking referrals and
utilization. Attends appropriate meetings to maintain up to date
knowledge of team and CHP activities. If unable to attend meetings,
contacts supervisor for information. Attends appropriate various
external organizational meetings with insurance companies and
hospitals. Maintains documentation to meet audit requirements and
participates in audit activities as requested. General:
Attendance/Punctuality - is consistently at work and on time.
Ensures work responsibilities are covered when absent. Handle and
process incoming patient correspondence. Participates in HRSA
activities as needed. Provide clear explanations of appropriate
patient-related policies. Maintains patient confidentiality in
accordance with established policies. All other duties as assigned.
Competencies: To perform the job successfully, an individual should
demonstrate the following competencies: Strong ability to
multi-task Maintains patient confidentiality Professional demeanor
and appearance Strong time management & prioritization skills
Customer service - manages difficult or emotional customer
situations Responds promptly to customer needs. Solicits customer
feedback to improve service. Responds to requests for service and
assistance. Meets commitments and is punctual. Follows policies and
procedures. Completes administrative tasks correctly and on time.
Supports organization's goals and values. Flexible and willing to
cover whichever tasks are most urgent based on changes in workload
and staffing. Clear communication amongst team to facilitate
patient needs and care. Essential Skills and 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.
At least one year of experience with the insurance authorization
process. Experience with medical terminology required. Strong
organizational, judgment, communication and analytical skills.
Ability to multi-task and perform multiple priorities. Cooperative
and professional behavior toward patients, peers, providers, third
party providers, management and visitors. Ability to promote
favorable image with patients, providers, insurance companies and
public. Ability to make decisions and solve problems. The ability
to contribute in a team environment and/or independently, to
provide excellent customer service. Experienced computer skills
with Microsoft Office and Athena. Spanish speaking/bilingual skills
are a plus. Education and Experience: High School Diploma or GED
required. At least 6 months of related experience and training.
Medical office experience is a plus. Medical Assistant
Certification is a plus.FULL-TIME/PART-TIME Full-TimePOSITION
Clinical Support SpecialistLOCATION MA, great barrington,
Administrative OfficesEOE STATEMENTWe are an equal employment
opportunity employer. All qualified applicants will receive
consideration for employment without regard to race, color,
religion, sex, national origin, disability status, protected
veteran status or any other characteristic protected by
law.PI175380394
Keywords: Community Health Program Inc, Springfield , Clinical Support Specialist, Healthcare , Great Barrington, Massachusetts
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