Clinic Operations Representative

Oct 05, 2021
Nov 09, 2021
Full Time
This position reports to the Clinic Operations Supervisor or Clinic Operations/Practice Manager. Provide patient services and administrative support in clinic operations. Interacts with parents, patients, physicians and other staff under moderate supervision in a courteous manner. Provide assistance to other employees within their department as well as other departments. Collect and verify all demographic information to ensure accuracy . May provide required notification of scheduled services according to managed care requirements. May be responsible for scheduling patients for specialty appointments. Position may be required to float to other clinics or ROCs for coverage. Next step in career ladder is Senior Clinic Operations Rep or Team Lead position.


Minimum Education
High School Diploma or GED

Minimum Work Experience
1 year of related experience. Experience performing billing, patient registration, and scheduling, medical insurance verification, insurance screening. Experience in health care setting preferred. (Required)

Required Skills/Knowledge
Broad clinic knowledge, customer service skills. Computer knowledge necessary. Microsoft Office experience preferred (Word & Excel). Complete Ambulatory Services training curriculum and pass all competency assessments, including a mock clinic. The ability to type minimum of 35 words per minute required.

Functional Accountabilities

Patient Services
1. Demonstrate accuracy of scheduling patients using the applicable scheduling system for the department.
2. Complete computer aided, on-line registration screen with parent/guardian via telephone or in person in professional & courteous manner.
3. Collect accurate demographic and insurance information. Update systems as needed in accordance with department standards for registration accuracy .
5. Reschedule appointment for patients who did not show or for the ancillary services cancellations by providers/technologist. Schedule follow up appointments at check out if applicable.
7. Greet patients and parents courteously. Arrive patient in appropriate system based on department policy .
8. Obtain required consents for department & ensure distribution of compliance related materials (i.e. HIPPA Privacy Notice, Patient Rights).
9. Obtain copy of insurance card and photo ID to be stored in medical record (copy or scan activity required). Ensure applicable insurance company and CNMC HIM department receive copies of appropriate forms/documentation. Complete all documentation in accordance with department policy and procedure.
10. Respond to patient portal work lists (i.e. appointment requests, fax queues, email requests, etc. May include messaging center work lists in the future).

Information Verification
1. Verify insurance eligibility using applicable eligibility system. Ensure managed care carve outs (lab and radiology carve outs) are adhered to.
2. Notify parents of the need for completed insurance referral form or pre-authorization prior to scheduled/unscheduled appointments.
3. Discuss co-payment, deposits, payment in full, or past due balance collections with parents prior to scheduled appointment in a professional & courteous manner.
5. Counsel parents or refer parent to Financial Information Center (FIC) for establishing payment schedule or method of payment.
6. Verify insurance information is complete prior to procedure and collect and verify pre-authorization/referral information: goal is to obtain authorizations 5 days in advance of service.
7. Utilize all systems where patient information may be stored (EPRS, SCI, Cerner, IDX, McKesson, etc.) to verify that systems are in sync

Cash Collection
1. Collect and record co-payments, deposits and payments in full and provide payer with receipt. Responsible for helping department meet 85% of the collection target for the department.
2. Maintain departmental requirements regarding cash controls and collections.

Billing Preparation
1. Reconcile schedules for upcoming clinic session to include ensuring that accounts are set up for billing and services requiring authorization are flagged: Activity should be completed 3-4 days in advance of clinic session; Areas with procedures requiring authorizations work standard may be 5-7 days.
2. Appropriately clear all walk-in and ensure scheduled/unscheduled appointments are linked to scheduling system.

Office Support
1. Answer telephone and address caller needs appropriately. Avoid transferring calls for better service to families. Meet department standards relative to ACD policies if applicable. Manage voice mail messages within same business day .
2. Distribute mail. May work returned mail as needed.
3. All staff are responsible for information distributed via e-mail. Staff should check work email a minimum of 3 times daily and respond to inquiries within 24 hours (or next business day).
4. Maintain office files and office supplies at P AR levels.
5. Maintain clean reception area and work space.
6. Other support as needed.

1. Speak up when team members appear to exhibit unsafe behavior or performance
2. Continuously validate and verify information needed for decision making or documentation
3. Stop in the face of uncertainty and takes time to resolve the situation
4. Demonstrate accurate, clear and timely verbal and written communication
5. Actively promote safety for patients, families, visitors and co-workers
6. Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance

Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law.

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