PRACTICE CRD 3

Job Description

Job Summary

As a patient-focused organization, UCSF Medical Center exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. UCSF Medical Center seeks faculty and staff that are committed to the values of professionalism, respect, integrity, diversity, and excellence that are integral to our mission.

The PC Authorization Coordinator is primarily responsible for securing financial clearance for the patient, provider, and health system. The coordinator works closely with the administrative, clinical and management teams to support practice operations and customer service recovery and intervention efforts. Provides support for financial clearance functions including authorizations, PAFRs, LOAs billing and RFIs.

Under the direction of the Revenue Manager and/or supervisor, the biller/auth rep will work independently to resolve billing related issues in APeX (Epic) to help maximize payor reimbursement and RVU charge capture. He/she must have an advanced understanding of healthcare terminology, processes and workflow and healthcare billing/authorizations in order to make good decisions and resolve account issues. The incumbent should also have outstanding people skills, including telephone technique, professional appearance, organizational skills, and communication skills (oral and written).

This position will also be responsible for performing detailed review of medical record documentation to answer billing/authorization level questions and will be responsible for working assigned authorization and billing work queues (WQs) on a daily basis to assist in keeping the denials at a minimum. He/she must have the ability to prioritize multiple tasks and work well with all levels of staffing including faculty, management, and coworkers both within and outside of the unit.

The PC is responsible for the maintenance of all routine clerical operations and communications. Adheres to the UCSF House and Telephone Standards and is sensitive to the needs of patients, staff and providers at all times. The PC is a team player who works closely with others and who is flexible in dealing with the changing priorities. Requires a self-reliant individual who synthesizes knowledge of practice operations in order to problem-solve, prioritize and facilitate complex transactions in the course of daily activities.

This position makes a difference for patients in an outpatient care unit by providing excellent customer service, facilitating and ensuring the accuracy of the information flow between medical, hospital staff and departments to maximize unit efficiency. The PC is required to work at any UCSF campus as needed and scheduled.

Qualifications

Required Qualifications - High School graduate or equivalent with four years related experience; or college degree and 6 months related experience; or equivalent combination of education and experience. - Successfully passes fingerprinting protocol and is approved to be a cash collector if applicable. - Strong computer skills, including basic keyboarding skills, and experience with at least two Office-type software programs (i.e., Outlook, Word and Excel). Proven ability to navigate through multiple patient records systems. Able to sit at a computer terminal with telephone headphones for extended period of time. - Ability to analyze situations, prioritizes, and develops solutions and makes recommendations. - Ability to work with minimal supervision - Ability to use good judgment and work independently, at times under the pressure of deadlines - Ability to access situations prioritizes workload, develop solutions and make recommendations. - Excellent customer service and communication/interpersonal skills, both over the telephone and directly. - Able to sit at a computer terminal with telephone headphones for extended periods of time. - Basic math skills required. - Proven ability to deal with a wide variety of individuals; - Ability to deal sensitively and effectively with patients. - Excellent organizational and problem-solving skills. - Strong writing skills to include the ability to compose, edit, and proof a wide variety of documents. - Demonstrated administrative/office coordination skills. - Demonstrated knowledge of medical practice terminology. - Within six months of start date, based upon completion of training, the Supervisor, completes the proficiency checklist with the employee. This includes the following areas if applicable - Referrals (Incoming referral entry) and handling all referral WQs - Schedule surgeries - Work applicable work queues - Enter/edit outside test results - Messaging (CRM) if applicable - 2nd calls in CRM if applicable - Telephone encounters - My open encounter - Staff message - New message - Route Patient advice request to providers (My Chart) - Patient Schedule (My Chart) - Letters - Pools - Patient look up - Check in process - Check out process - Comment field - Quick note - Scanning Preferred Qualifications - Demonstrated experience in health care (may include medical, dental or veterinary) in the following areas: patient scheduling, insurance verification, medical record data abstraction, or patient financial services. - Prior experience with appointment, ancillary service or surgical scheduling or a combination of all three. - Bi-lingual or multi-lingual capability (Spanish, Cantonese, and Russian) strongly preferred. - Prior experience with EPIC.