Patient Service Representative
Patient service representative job at The CORE Institute
Job Description
At The CORE Institute, we are dedicated to taking care of you so you can take care of business! Our robust benefits package includes the following:
Competitive Health & Welfare Benefits
Monthly $43 stipend to use toward ancillary benefits
HSA with qualifying HDHP plans with company match
401k plan after 6 months of service with company match (Part-time employees included)
Employee Assistance Program that is available 24/7 to provide support
Employee Appreciation Days
Employee Wellness Events
Qualifications
High school diploma/GED or equivalent is required.
1-2 years of experience in a hospital, medical office, or customer service setting (preferred).
Familiar with and understand Medicare, Medicaid and other government payors and HMO/PPO payors guidelines and principals.
Understands benefits (i.e.: deductibles, copays, and coinsurance) and how to calculate estimates per the payor contract as applicable.
Previous patient registration in a medical office, hospital or outpatient surgery center.
Medicare, Medicaid and other government payor guidelines.
Clear understanding of insurance benefits and how to calculate patient responsibility.
Knowledge of Patient Registration.
Strong customer service and communication skills.
Ability to communicate patient responsibility clearly with patients, communicate with physician's office staff, payors and hospital teammates.
Ability to resolve issues in a professional manner.
Ability to work independently with minimal supervision.
Essential Functions
Greet patients, families, and visitors in a courteous and professional manner.
Answer and route incoming patient calls promptly and professionally.
Maintain a clean and organized front desk area.
Maintain confidentiality and compliance with HIPAA and hospital policies.
Assist with other clerical or administrative tasks as assigned.
Maintain a clean and organized work environment and ensure supplies are stocked.
Collaborate with other departments to ensure smooth patient flow and timely service.
Initiate and announce overhead emergency codes, including "Code Red" in the event of fire or smoke detection, following facility procedures.
Respond calmly and appropriately to emergency situations, including notifying security and/or emergency response teams.
Collect and verify patient demographics, insurance information, and required documentation.
Input accurate patient data into the hospital EMR system.
Prepare patient charts in advance of scheduled appointments to ensure all required documentation is complete and accurate. Include all necessary forms, such as consent forms. Patient Estimate Letters and procedure-specific paperwork
Obtain patient signatures for consent forms, insurance authorizations, and privacy acknowledgments.
Provide patients with information on hospital policies, procedures, and financial responsibilities.
Coordinate with clinical and billing departments to ensure proper patient flow and documentation.
Respond to patient and visitor inquiries and resolve registration issues efficiently.
Confirm and document insurance information to reduce the risk of claim denials.
Explain financial responsibility to patients when appropriate.
Accept and process payments for co-pays or deposits, when necessary.
Be familiar with individual payor guidelines and the process of collecting over the counter payments/deductibles/co-pay/coinsurance. Knowledge of payor contracts including Medicare, Medicaid and other government contracts and guidelines.
Investigate questionable information promptly, i.e. MVA and work comp information that conflicts with insurer information.
Notify Business Office Manager and Physician Office of any benefit, financial or authorization concerns or issues immediately.
Work two weeks ahead of surgeries to avoid late notice cancellations.
Contact patients in advance of their scheduled imaging appointments to provide information about their financial responsibility (e.g., co-pays, deductibles, self-pay estimates).
Review and explain out-of-pocket costs clearly and answer any patient questions regarding their financial obligation.
Work with patients to establish payment arrangements prior to their arrival, including setting up payment plans when appropriate and in accordance with organization policy.
Document all financial discussions and agreements and save this information in the appropriate system or shared folder for team access.
Ensure all payment plans are properly recorded and accessible to staff and billing teams to avoid confusion
Review entered information with patient to ensure accuracy.
Scan photo identification and insurance card(s) into EMR. Make any corrections to insurance information upon review of insurance card(s) when necessary.
Request Living Will/Advance Directives. Provide information if requested on where to obtain information on said forms to patient. Document when patient requests information and that it was provided in order to meet state and Joint Commission requirements.
Complete Medicare MSP questionnaire when necessary.
Collect patient responsibility upon admission.
Obtain patient signature on required forms.
Print labels and wristband and Facesheets. Review patient information with the patient and confirm accuracy after applying the wristband. Take chart with labels to Pre-op to notify nurses that patient is registered.
Meet or exceed monthly, quarterly and yearly cash collection goals.
Discusses patient information with other health team members in an appropriate environment.
Interacts with all patients, families, visitors and fellow teammates in a mature, responsible manner to ensure a positive and professional facility environment.
Must have a clear understanding of KPI and Metric's measures and ability to complete daily tasks to meet Departmental and Hospital measures.
Schedule, reschedule, and cancel imaging appointments as needed
Communicate prep instructions for various imaging procedures (e.g., MRI, CT, X-ray)
Coordinate with imaging technologists and other departments to ensure proper patient flow
Verify imaging orders to ensure all information is accurate, complete, and matches the scheduled exam (e.g., exam type, body part, laterality, clinical indications).
If discrepancies or missing information are identified, follow established procedures to contact the ordering provider or their office to obtain a corrected or updated order.
Ensure all orders are finalized and properly documented in the patient chart prior to the appointment to avoid delays in care and ensure compliance with regulatory requirements.
Contact patients in advance to confirm their upcoming imaging appointments.
Verify appointment details including date, time, location, and type of exam.
Provide patients with any necessary preparation instructions (e.g., fasting, medication restrictions) specific to their imaging procedure.
Address any patient questions or concerns and ensure they understand check-in procedures and arrival time expectations.
Document confirmation in the appropriate system or communication log.
Other duties as assigned.
Medical Office Scheduler II
Patient service representative job at The CORE Institute
Job Description
Come join our amazing Team!
Benefits:
Competitive Health & Welfare Benefits
Monthly $43 stipend to use toward ancillary benefits
HSA with qualifying HDHP plans with company match
401k plan after 6 months of service with company match (Part-time employees included)
Employee Assistance Program that is available 24/7 to provide support
Employee Appreciation Days
Employee Wellness Events
Minimum Qualifications:
Minimum 1 year of experience in the healthcare field is required, previous call center experience is preferred.
Excellent organizational skills and strong customer service orientation are required with a strong background in computers and data entry.
Knowledge of medical terminology and insurance plans.
Essential Functions
Schedule clinic appointments including consultations and follow-up visits, utilizing the EMR and scheduling tool.
Collect all pertinent demographic information, insurance information, and medical information.
Utilizes scheduling tools and a referral system to schedule patient appointments.
Confirm patient is eligible with insurance plan at the time the appointment is scheduled.
Utilized referral system to process referral, contact the patient to schedule appointment and import referral/documents into patient's chart.
Answer and resolve all incoming calls and requests in a timely and accurate manner.
Communicate with supervisor and/or leads about potential patient concerns.
Triage and relay necessary messages to appropriate staff members.
Participates in the daily operations of processing the patient appointment requests as a team alongside the pre-registration team.
Ensure strict confidentiality of all health records and member information.
Meets HIPAA guidelines.
Other duties assigned
PT Test Scheduler
Patient service representative job at The CORE Institute
Job Description
ESSENTIAL FUNCTIONS
Schedules tests for the patient within the practice management program or at outside facilities based on insurance, patient preference, physician preference, and or location.
Gathers pertinent information from insurance carriers, physicians, and patient charts to make certain of appropriate matching to contracted service providers.
Call patients to schedule tests within the required time as designated by policies and procedures.
Provides ongoing follow-up until successful execution of referral.
Responds to patient questions and complaints as required resolving problems and maintaining high patient satisfaction levels.
Communicates clinical instructions needed for appointments/procedures.
Input required data to GE practice management to include administrative comments and coded notes.
Accurately updates patient information in the practice management system and EMR as well as any changes or additions to the schedule and performs all required documentation of work completed.
Effectively understands and proactively manages and schedules providers with front office personnel.
Schedule appointments in the timeframe that allows for appropriate follow-up and execution of authorization as designated by policies and procedures.
EDUCATION
High school diploma/GED or equivalent working knowledge preferred.
EXPERIENCE
0-2 years of test scheduling experience or related experience.
Must be able to communicate effectively with physicians, patients, and the public and be capable of establishing good working relationships with both internal and external customers.
REQUIREMENTS
Able to complete and manage per department metrics.
Ensure 100% of required certifications and authorizations have been obtained.
KNOWLEDGE
Knowledge of insurance plans.
Knowledge of computer systems.
Knowledge of grammar, spelling, and punctuation to type patient information.
SKILLS
Skill in customer service and an understanding of The code of conduct and culture.
Skill in communicating effectively with physicians, clinical staff, hospital staff, and the public.
Skill in establishing good working relationships with both internal and external customers.
ABILITIES
Ability to maintain patient confidentiality.
Ability to communicate with upset and frustrated patients.
Ability to obtain patient history and medical history.
Ability to work on multiple projects and prioritize tasks. Ability to meet time-sensitive goals.
ENVIRONMENTAL WORKING CONDITIONS
Normal office environment.
PHYSICAL/MENTAL DEMANDS
Requires sitting and standing associated with a normal office environment.
Some bending and stretching are required.
Manual dexterity using a computer keyboard, phone, and scanner.
Surgery Scheduler
Patient service representative job at The CORE Institute
Job Description
Benefits:
$18-19/hr
Monthly Performance Bonus!!
Competitive Health & Welfare Benefits
Monthly $43 stipend to use toward ancillary benefits
HSA with qualifying HDHP plans with company match
401k plan after 6 months of service with company match (Part-time employees included)
Employee Assistance Program that is available 24/7 to provide support
Employee Appreciation Days
Employee Wellness Events
Minimum Qualifications:
2 years of medical office scheduling or 1-2 years of administration experience combined with orthopedic clinic experience
Excellent organizational skills and strong customer service orientation are required with a strong background in computers and data entry.
Knowledge of medical terminology and insurance plans.
Essential Functions
Tracks and obtains medical clearances for scheduled surgeries.
Navigates EMR to scribe voicemails and return appropriate calls as needed.
Call patients to schedule surgery within 48 hours of the order being signed and schedule all pre-op and post-op appointments for the patient.
Provides ongoing communication with patients regarding pre-certification, authorization, financial counseling, and scheduling process.
During the financial counseling session, collects patients' responsibility via telephone or instructs patients to bring required payment to their Pre-op appointment.
Communicates clinical instructions needed for appointments/procedures.
Updates the system for any changes or additions to the schedule.
Accurately updates patient information in the practice management system and EMR.
Ensures canceled appointments and related ancillary appointments are canceled and communicated to all stakeholders.
Other duties as assigned.
Medical Office Scheduler II
Patient service representative job at The CORE Institute
Job Description
Come join our amazing Team!
Benefits:
Competitive Health & Welfare Benefits
Monthly $43 stipend to use toward ancillary benefits
HSA with qualifying HDHP plans with company match
401k plan after 6 months of service with company match (Part-time employees included)
Employee Assistance Program that is available 24/7 to provide support
Employee Appreciation Days
Employee Wellness Events
Minimum Qualifications:
Minimum 1 year of experience in the healthcare field is required, previous call center experience is preferred.
Excellent organizational skills and strong customer service orientation are required with a strong background in computers and data entry.
Knowledge of medical terminology and insurance plans.
Essential Functions
Schedule clinic appointments including consultations and follow-up visits, utilizing the EMR and scheduling tool.
Collect all pertinent demographic information, insurance information, and medical information.
Utilizes scheduling tools and a referral system to schedule patient appointments.
Confirm patient is eligible with insurance plan at the time the appointment is scheduled.
Utilized referral system to process referral, contact the patient to schedule appointment and import referral/documents into patient's chart.
Answer and resolve all incoming calls and requests in a timely and accurate manner.
Communicate with supervisor and/or leads about potential patient concerns.
Triage and relay necessary messages to appropriate staff members.
Participates in the daily operations of processing the patient appointment requests as a team alongside the pre-registration team.
Ensure strict confidentiality of all health records and member information.
Meets HIPAA guidelines.
Other duties assigned
PT Medical Test Scheduler
Patient service representative job at The CORE Institute
Job Description
Minimum Qualifications:
1-2 years of test scheduling experience or related experience.
Must be able to communicate effectively with physicians, patients, and the public and be capable of establishing good working relationships with both internal and external customers.
Preferred: Knowledge of insurance plans
Essential Functions
Schedules tests for the patient within the designated practice management program or at outside facilities based on insurance, patient preference, physician preference, and or location.
Gathers pertinent information from insurance carriers, physicians, and patient charts to make certain of the patient's financial obligation for services.
Call patients to schedule tests within the required time as designated by policies and procedures.
Provides ongoing communication with patients regarding pre-certification, authorization, financial counseling, and scheduling process.
Responds to patient questions and complaints as required resolving problems and maintaining high patient satisfaction levels.
Communicates clinical instructions needed for appointments/procedures.
Input required data to include referrals plus and coded notes.
Accurately updates patient information in the practice management system and EMR as well as any changes or additions to the schedule. Performs all required documentation of work completed.
Accurately updates patient information in the practice management system and EMR as well as any changes or additions to the schedule. Performs all required documentation of work completed.
Initiate authorization for the test within the required time as designated by policies and procedures.
About us:
The Center for Orthopedic Research and Education, We don't mean to brag but did you know The CORE Institute has been ranked by Ranking Arizona: The Best of Arizona Businesses!?
• #1 for Orthopedic Practices
• #1 for Healthiest Healthcare Employers
• #3 for Best Healthcare Workplace Culture
• Winner in Best Places to Work
Medical Office Scheduler
Patient service representative job at The CORE Institute
Job Description
Come join our amazing team!
Benefits:
Competitive Health & Welfare Benefits
HSA with qualifying HDHP plans with company match
401k plan after 6 months of service with company match (Part-time employees included)
Employee Assistance Program that is available 24/7 to provide support
Employee Appreciation Days
Employee Wellness Events
Minimum Qualifications:
Minimum 1 year of experience in the healthcare field is required, previous call center experience is preferred.
Excellent organizational skills and strong customer service orientation are required with a strong background in computers and data entry.
Knowledge of medical terminology and insurance plans.
Essential Functions
Schedule clinic appointments including consultations and follow-up visits, utilizing the EMR and scheduling tool.
Collect all pertinent demographic information, insurance information, and medical information.
Utilizes scheduling tools and a referral system to schedule patient appointments.
Confirm patient is eligible with insurance plan at the time the appointment is scheduled.
Utilized referral system to process referral, contact the patient to schedule appointment and import referral/documents into patient's chart.
Answer and resolve all incoming calls and requests in a timely and accurate manner.
Communicate with supervisor and/or leads about potential patient concerns.
Triage and relay necessary messages to appropriate staff members.
Participates in the daily operations of processing the patient appointment requests as a team alongside the pre-registration team.
Ensure strict confidentiality of all health records and member information.
Meets HIPAA guidelines
Surgery Scheduler
Patient service representative job at The CORE Institute
Job Description
Benefits:
$18-19/hr
Monthly Performance Bonus!!
Competitive Health & Welfare Benefits
Monthly $43 stipend to use toward ancillary benefits
HSA with qualifying HDHP plans with company match
401k plan after 6 months of service with company match (Part-time employees included)
Employee Assistance Program that is available 24/7 to provide support
Employee Appreciation Days
Employee Wellness Events
Minimum Qualifications:
2 years of medical office scheduling or 1-2 years of administration experience combined with orthopedic clinic experience
Excellent organizational skills and strong customer service orientation are required with a strong background in computers and data entry.
Knowledge of medical terminology and insurance plans.
Essential Functions
Tracks and obtains medical clearances for scheduled surgeries.
Navigates EMR to scribe voicemails and return appropriate calls as needed.
Call patients to schedule surgery within 48 hours of the order being signed and schedule all pre-op and post-op appointments for the patient.
Provides ongoing communication with patients regarding pre-certification, authorization, financial counseling, and scheduling process.
During the financial counseling session, collects patients' responsibility via telephone or instructs patients to bring required payment to their Pre-op appointment.
Communicates clinical instructions needed for appointments/procedures.
Updates the system for any changes or additions to the schedule.
Accurately updates patient information in the practice management system and EMR.
Ensures canceled appointments and related ancillary appointments are canceled and communicated to all stakeholders.
Other duties as assigned.
Credentialing Specialist
Patient service representative job at The CORE Institute
Job Description
Healthcare Outcomes Performance Company is a vertically integrated musculoskeletal outcomes management company. HOPCo manages physician practices, hospital service lines, population health and value-based care programs, and musculoskeletal delivery networks.
HOPCo is the managing partner of Arizona-based entities, CORE Institute, Northern Arizona Orthopaedics, CORE Institute Specialty Hospital, Michigan-based CORE Institute, and Florida-based Southeast Orthopedic Specialists Clinics and Musculoskeletal Specialty Hospital.
As HOPCo continues to grow, we are looking for a Credentialing Specialist to join the Credentialing Team. Please see below for the functions and requirements for this position.
ESSENTIAL FUNCTIONS
Reviews and completes hospital and payor applications for all health care providers.
Completes verification forms/letters for outside facilities.
Maintain billing insurance grid, provider insurance grid and each individual physician's spreadsheet up to date on current insurance changes.
Track and maintain physician licensure(s), certification and CME credits.
Maintain practitioner credentialing files.
Maintain practitioner electronic file by keeping all applications/licensure current.
Maintains all renewal applications for both hospitals/insurances.
Has knowledge of Employee Handbook content along with established policies and procedures.
Relies on instructions and pre-established guidelines to perform the functions of the job.
Assists the Credentialing Supervisor in their job responsibilities/duties when necessary.
EDUCATION
High school diploma/GED or equivalent working knowledge preferred.
EXPERIENCE
3-4 years of related experience
REQUIREMENTS
Must be able to communicate effectively with physicians, providers, licensing agencies, insurance payors and the public and be capable of establishing good working relationships with both internal and external customers.
Some knowledge of insurance billing and hospital credentialing a plus.
KNOWLEDGE
Knowledge of the credentialing process.
Knowledge of computer systems.
Knowledge of credentialing paperwork and timelines.
Knowledge of credentialing timelines and regulations.
SKILLS
Skill in establishing good working relationships with internal and external customers.
Skill in organizing daily work assignments for various providers.
Skill in managing multiple work assignments and set priorities.
ABILITIES
Ability to establish good working relationships with internal and external customers.
Ability to communicate effectively with physicians, credentialing agencies and staff.
Ability to be organized and efficient in daily work activities/projects.
ENVIRONMENTAL WORKING CONDITIONS
Normal office environment.
Some travel within community.
PHYSICAL/MENTAL DEMANDS
Requires sitting and standing associated with a normal office environment.
Some bending and stretching required.
Manual dexterity using a calculator and computer keyboard.
#HOP
Credentialing Specialist
Patient service representative job at The CORE Institute
Job Description
Healthcare Outcomes Performance Company is a vertically integrated musculoskeletal outcomes management company. HOPCo manages physician practices, hospital service lines, population health and value-based care programs, and musculoskeletal delivery networks.
HOPCo is the managing partner of Arizona-based entities, CORE Institute, Northern Arizona Orthopaedics, CORE Institute Specialty Hospital, Michigan-based CORE Institute, and Florida-based Southeast Orthopedic Specialists Clinics and Musculoskeletal Specialty Hospital.
As HOPCo continues to grow, we are looking for a Credentialing Specialist to join the Credentialing Team. Please see below for the functions and requirements for this position.
ESSENTIAL FUNCTIONS
Reviews and completes hospital and payor applications for all health care providers.
Completes verification forms/letters for outside facilities.
Maintain billing insurance grid, provider insurance grid and each individual physician's spreadsheet up to date on current insurance changes.
Track and maintain physician licensure(s), certification and CME credits.
Maintain practitioner credentialing files.
Maintain practitioner electronic file by keeping all applications/licensure current.
Maintains all renewal applications for both hospitals/insurances.
Has knowledge of Employee Handbook content along with established policies and procedures.
Relies on instructions and pre-established guidelines to perform the functions of the job.
Assists the Credentialing Supervisor in their job responsibilities/duties when necessary.
EDUCATION
High school diploma/GED or equivalent working knowledge preferred.
EXPERIENCE
3-4 years of Credentialing experience.
REQUIREMENTS
Must be able to communicate effectively with physicians, providers, licensing agencies, insurance payors and the public and be capable of establishing good working relationships with both internal and external customers.
Some knowledge of insurance billing and hospital credentialing a plus.
KNOWLEDGE
Knowledge of the credentialing process.
Knowledge of computer systems.
Knowledge of credentialing paperwork and timelines.
Knowledge of credentialing timelines and regulations.
SKILLS
Skill in establishing good working relationships with internal and external customers.
Skill in organizing daily work assignments for various providers.
Skill in managing multiple work assignments and set priorities.
ABILITIES
Ability to establish good working relationships with internal and external customers.
Ability to communicate effectively with physicians, credentialing agencies and staff.
Ability to be organized and efficient in daily work activities/projects.
ENVIRONMENTAL WORKING CONDITIONS
Normal office environment.
Some travel within community.
PHYSICAL/MENTAL DEMANDS
Requires sitting and standing associated with a normal office environment.
Some bending and stretching required.
Manual dexterity using a calculator and computer keyboard.
#HOP
Front Office Representative- Part Time
Patient service representative job at The CORE Institute
Job Description
Benefits:
Starting at $18 DOE
Competitive Health & Welfare Benefits
HSA with qualifying HDHP plans with company match
401k plan after 6 months of service with company match (Part-time employees included)
Employee Assistance Program that is available 24/7 to provide support
Employee Appreciation Days
Employee Wellness Events
ESSENTIAL FUNCTIONS
Presents a professional image and helpful demeanor to our patients and visitors.
Greets and directs patients and visitors upon their arrival into the Lobby.
Answers the telephone and direct calls appropriately throughout the facility.
Maintains full confidentiality of all patient information.
Assists Facilities and Security personnel in announcing Code Red drills and alarms.
Working knowledge of the Elevation Ambulatory Surgery Center and Northern Arizona Orthopedics check in processes and EMR requirements.
Other duties as assigned
EDUCATION
High school diploma/GED or equivalent working knowledge preferred.
EXPERIENCE
Preference is given to candidates with a minimum of two years of receptionist experience in a medical office or healthcare setting.
Medical Biller/Insurance follow up
Patient service representative job at The CORE Institute
Job Description
Benefits:
$18-$21
Competitive Health & Welfare Benefits
Monthly $43 stipend to use toward ancillary benefits
HSA with qualifying HDHP plans with company match
401k plan after 6 months of service with company match (Part-time employees included)
Employee Assistance Program that is available 24/7 to provide support
Employee Appreciation Days
Employee Wellness Events
Minimum Qualifications:
Minimum two to three years of experience in medical billing.
Must be able to communicate effectively with physicians, patients, and the public and be capable of establishing good working relationships with both internal and external customers.
HSD/GED
Preferred:
Knowledge of computer systems. Experience with GE patient management system p
Knowledge of the physician billing processes, ICD-10, and CPT coding.
Essential Functions
Reviews insurance denials and rejections to determine the next appropriate action steps and obtain the necessary information to resolve any outstanding denials/rejections.
Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
Verifies receipt of claim with insurance plans, determining the next appropriate action steps and timeliness of claims maximum reimbursement.
Researches all information needed to complete the billing process including obtaining information from providers, ancillary services staff, and patients.
Obtains and attaches referrals/authorizations to appointments/charges.
Maintains productivity and accuracy metrics per department expectations and AEIOU Behavioral Standards.
Assumes full responsibility for reducing the accounts receivable of insurance balances by working through outstanding accounts.
Analyzes account for proper claims processing and payment posting through inquiries from patients or staff.
Identifies and communicates trends and/or potential issues to the management team.
Follows and maintains all HOPCo policies and procedures, including those specific to billing and the Revenue Cycle.
About us:
The Center for Orthopedic Research and Education, We don't mean to brag but did you know The CORE Institute has been ranked by Ranking Arizona: The Best of Arizona Businesses!?
• #1 for Orthopedic Practices
• #1 for Healthiest Healthcare Employers
• #3 for Best Healthcare Workplace Culture
• Winner in Best Places to Work
Front Office Representative
Patient service representative job at The CORE Institute
Job Description
Minimum Qualifications:
Minimum of one - two years of patient registration experience in a medical office or healthcare setting
Must be able to communicate effectively with physicians, patients, and the public and be capable of establishing good working relationships with both internal and external customers.
Requires knowledge of insurance rules and regulations, medical terminology, and computer scheduling systems
HSD/GED
Preferred:
Bilingual (English/Spanish) strongly preferred.
Previous experience in collecting money is preferred.
Essential Functions
Promptly greets and acknowledges patients. Informs MAs and Providers of the patient's arrival
Instructs patients in completion of medical history and patient information forms and makes any necessary corrections to the patient's account.
Obtains accurate, complete demographic and insurance information and financial contract/consent on patient paperwork, as well as reviewing patients and guarantors to obtain accurate information assuring all necessary documents are populated and signed correctly. Ensure all required authorizations and/or referrals are attached to the appointment for that DOS.
Responsible for identifying and collecting co-payments, co-insurances, and past-due account balances.
Explains financial requirements to the patient in response to patient questions on billing and insurance matters; refers questions regarding more complex insurance/benefits questions to Site Billing Specialist.
Evaluates patient financial status and establishes payment plans based upon authority levels.
Responsible for accurately completing and interpreting insurance verification and benefits. Notifies patients, family members, physicians, and/or supervisors of network insurance coverage issues that may result in coverage reduction.
Scans all new or updated patient information into the computer (including photo ID, insurance cards, referrals, and patient paperwork).
Schedules follow-up appointments, reviews patient's insurance coverage and notifies patient if service requires an authorization or referral, and sends the request to PCP.
Maintains general knowledge of insurance plans accepted by HOPCo.
Communicates with the patients in the lobby if the physician or provider is running behind schedule.
Responsible for maintaining a secure and accurate cash drawer. Responsible for daily balancing of the cash drawer and closing batch.
Maintains strictest patient confidentiality.
Maintains a clean and organized front office workspace.
Follows established Front Office SOP's.
The job holder must demonstrate current competencies for the job position including a general understanding of insurance requirements.
Referral and Authorization Coordinator
Patient service representative job at The CORE Institute
Job Description
Benefits:
Salary $18-20
Supporting CISH ( Core Institute Specialty Hospital) and Elevation Surgery centers
Competitive Health & Welfare Benefits
Monthly $43 stipend to use toward ancillary benefits
HSA with qualifying HDHP plans with company match
401k plan after 6 months of service with company match (Part-time employees included)
Employee Assistance Program that is available 24/7 to provide support
Employee Appreciation Days
Employee Wellness Events
Minimum Qualifications:
Must have Healthcare experience with Managed Care Insurance, requesting Referrals, Authorizations for Insurance and verifying Insurance benefits.
In-depth knowledge on insurance plan requirements for Medicaid and commercial plans.
Minimum two to three years of experience in a healthcare environment in and prior auth experience
Essential Functions
Verifies and updates patient registration information in the practice management system.
Obtains benefit verification and necessary authorizations (referrals, precertification) prior to patient arrival for all ambulatory visits, procedures, injections, and radiology services
Uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility.
Creates appropriate referrals to attach to pending visits.
Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
Completes chart prepping tasks daily to ensure smooth check-in process for the patient and clinic.
Researches all information needed to complete registration process including obtaining information from providers, ancillary services staff and patients.
Fax referral form to providers that do not require any records to be sent. Be able to process 75-80 referrals on a daily basis. For primary specialty office visits, fax referral/authorization form to PCPs and insurance companies in a timely fashion.
Reviews and notifies front office staff of outstanding patient balances.
Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue goals.
Respond to In-house provider and support staff questions, requests, and concerns regarding the status of patient referrals, care coordination or follow-up status.
Identifies and communicates trends and/or potential issues to management team.
Index referrals to patient accounts for existing patients.
Create new patient accounts for non-established patients to index referrals.
The job holder must demonstrate current competencies for job position.
Surgical Authorization Specialist
Patient service representative job at The CORE Institute
Job Description
Benefits:
Starting at $19.00
Competitive Health & Welfare Benefits
Monthly $43 stipend to use toward ancillary benefits
HSA with qualifying HDHP plans with company match
401k plan after 6 months of service with company match (Part-time employees included)
Employee Assistance Program that is available 24/7 to provide support
Employee Wellness Events
Minimum Qualifications:
A minimum of 2 years of experience in the healthcare field is required and previous experience in referrals/authorizations, front office, and/or charge posting is preferred.
Excellent organizational skills and strong customer service orientation are required with a strong background in computers and data entry.
Working knowledge of eligibility, verification of benefits, and prior authorizations from various HMOs, PPOs, commercial payers, and other funding sources.
Essential Functions
Monitors the authorizations of upcoming surgical cases on the physician's calendars ensuring authorizations for surgeries are obtained in a timely and accurate manner.
Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms necessary information to allow processing of claims to insurance plans.
completes surgical cost analysis form, documenting the required surgical cost estimation for collection prior to services.
Verifies benefits on all surgical procedures.
Document authorizations and progress of authorizations in the patient's chart. Enters the authorization information within case management.
Must be able to communicate effectively with physicians, patients, and co-workers and be capable of establishing good working relationships with both internal and external customers.
Participate in providing ongoing training and education of staff as it relates to new processes to ensure timely confirmation of surgical cases.
Work with the department manager to respond to and reduce complaints timely and professional.
Assist surgery schedulers with STAT authorizations.
Ensure strict confidentiality of all health records, member information and meet HIPAA guidelines.
Assists in identifying opportunities for improvement within the daily workflow process.
Attends department meetings as required.
Surgical Authorization Specialist
Patient service representative job at The CORE Institute
Job Description
Benefits:
Competitive Health & Welfare Benefits
Monthly $43 stipend to use toward ancillary benefits
HSA with qualifying HDHP plans with company match
401k plan after 6 months of service with company match (Part-time employees included)
Employee Assistance Program that is available 24/7 to provide support
Employee Wellness Events
Minimum Qualifications:
A minimum of 2 years of experience in the healthcare field is required and previous experience in referrals/authorizations, front office, and/or charge posting is preferred.
Excellent organizational skills and strong customer service orientation are required with a strong background in computers and data entry.
Working knowledge of eligibility, verification of benefits, and prior authorizations from various HMOs, PPOs, commercial payers, and other funding sources.
Essential Functions
Monitors the authorizations of upcoming surgical cases on the physician's calendars ensuring authorizations for surgeries are obtained in a timely and accurate manner.
Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms necessary information to allow processing of claims to insurance plans.
completes surgical cost analysis form, documenting the required surgical cost estimation for collection prior to services.
Verifies benefits on all surgical procedures.
Document authorizations and progress of authorizations in the patient's chart. Enters the authorization information within case management.
Must be able to communicate effectively with physicians, patients, and co-workers and be capable of establishing good working relationships with both internal and external customers.
Participate in providing ongoing training and education of staff as it relates to new processes to ensure timely confirmation of surgical cases.
Work with the department manager to respond to and reduce complaints timely and professional.
Assist surgery schedulers with STAT authorizations.
Ensure strict confidentiality of all health records, member information and meet HIPAA guidelines.
Assists in identifying opportunities for improvement within the daily workflow process.
Attends department meetings as required.
Front Office Representative- PT
Patient service representative job at The CORE Institute
Job Description
Minimum Qualifications:
Minimum of one - two years of patient registration experience in a medical office or healthcare setting
Must be able to communicate effectively with physicians, patients, and the public and be capable of establishing good working relationships with both internal and external customers.
Requires knowledge of insurance rules and regulations, medical terminology, and computer scheduling systems
HSD/GED
Preferred:
Bilingual (English/Spanish) strongly preferred.
Previous experience in collecting money is preferred.
Essential Functions
Promptly greets and acknowledges patients. Informs MAs and Providers of the patient's arrival
Instructs patients in completion of medical history and patient information forms and makes any necessary corrections to the patient's account.
Obtains accurate, complete demographic and insurance information and financial contract/consent on patient paperwork, as well as reviewing patients and guarantors to obtain accurate information assuring all necessary documents are populated and signed correctly. Ensure all required authorizations and/or referrals are attached to the appointment for that DOS.
Responsible for identifying and collecting co-payments, co-insurances, and past-due account balances.
Explains financial requirements to the patient in response to patient questions on billing and insurance matters; refers questions regarding more complex insurance/benefits questions to Site Billing Specialist.
Evaluates patient financial status and establishes payment plans based upon authority levels.
Responsible for accurately completing and interpreting insurance verification and benefits. Notifies patients, family members, physicians, and/or supervisors of network insurance coverage issues that may result in coverage reduction.
Scans all new or updated patient information into the computer (including photo ID, insurance cards, referrals, and patient paperwork).
Schedules follow-up appointments, reviews patient's insurance coverage and notifies patient if service requires an authorization or referral, and sends the request to PCP.
Maintains general knowledge of insurance plans accepted by HOPCo.
Communicates with the patients in the lobby if the physician or provider is running behind schedule.
Responsible for maintaining a secure and accurate cash drawer. Responsible for daily balancing of the cash drawer and closing batch.
Maintains strictest patient confidentiality.
Maintains a clean and organized front office workspace.
Follows established Front Office SOP's.
The job holder must demonstrate current competencies for the job position including a general understanding of insurance requirements.
About us:
The Center for Orthopedic Research and Education, We don't mean to brag but did you know The CORE Institute has been ranked by Ranking Arizona: The Best of Arizona Businesses!?
#1 for Orthopedic Practices
#1 for Healthiest Healthcare Employers
#3 for Best Healthcare Workplace Culture
Winner in Best Places to Work
OR Schedule Coordinator
Patient service representative job at The CORE Institute
Job Description
At The CORE Institute, we are dedicated to taking care of you so you can take care of business! Our robust benefits package includes the following:
Competitive Health & Welfare Benefits
HSA with qualifying HDHP plans with company match
401k plan with company match (Part-time employees included)
Employee Assistance Program that is available 24/7 to provide support
Employee Wellness Events
Minimum Qualifications:
High school diploma/GED is required.
Two years of scheduling experience preferred.
Essential Functions:
Schedules surgical procedures based on booking sheets received from physician's office.
Ensures that the information in the scheduling software is complete and correct by comparing the scheduled procedure with the original booking sheet.
Communicates with individual schedulers in a professional and collaborative manner.
Communicates all lineup changes, add-on, and cancellations with the OR Manager and OR Charge Nurse.
Builds surgical charts to include all paperwork received from the physician's office.
Runs reports from scheduling software as requested.
Coordinates anesthesia coverage based on number of rooms running, and case lineup.
Assumes other related responsibilities as required and assigned.
Referral and Authorization Coordinator
Patient service representative job at The CORE Institute
Job Description
ESSENTIAL FUNCTIONS
Verifies and updates patient registration information in the practice management system.
Obtains benefit verification and necessary authorizations (referrals, precertification) after patient arrival for all ambulatory visits, procedures, injections, and radiology services.
Uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility.
Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
Completes chart prepping tasks daily to ensure a smooth check-in process for the patient and clinic.
Researches all information needed to complete the registration process including obtaining information from providers, ancillary services staff, and patients.
Reviews and notifies front office staff of outstanding patient balances.
Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue goals.
Respond to In-house provider and support staff questions, requests, and concerns regarding the status of patient referrals, care coordination, or follow-up status.
Identifies and communicates trends and/or potential issues to the management team.
Index referrals to patients account for existing patients.
Create new patient accounts for non-established patients to index referrals.
Assist in training new team members as directed
Maintain current knowledge of payer authorization requirements across commercial, Medicare, Medicaid, and managed care plans.
Communicate with physician offices, patients, and payers to ensure all necessary authorizations are in place prior to the date of service.
Document all payer communications, authorization status, and outcomes in the electronic medical record (EMR) or patient account system.
Collaborate with clinical, registration, and billing staff to avoid service delays and ensure clean claim submission.
EDUCATION
High school diploma/GED or equivalent working knowledge preferred.
EXPERIENCE
Minimum two to three years of experience in a healthcare environment in a referral, front desk, or billing role.
Must be able to communicate effectively with physicians, patients, and the public and be capable of establishing good working relationships with both internal and external customers.
Working knowledge of Centricity Practice Management and Centricity EMR a plus.
REQUIREMENTS
Must have healthcare experience with managed care insurances, requesting referrals, authorizations for insurances, and verifying insurance benefits.
In-depth knowledge of insurance plan requirements for Medicaid and commercial plans.
KNOWLEDGE
Working knowledge of eligibility verification and prior authorizations for payment from various HMOs, PPOs, commercial payers, and other funding sources.
Knowledge of government provisions and billing guidelines including Coordination of Benefits.
Advanced computer knowledge, including Window based programs.
SKILLS
Skilled in defusing difficult situations and able to be consistently pleasant and helpful.
Skill in using computer programs and applications.
Skill in establishing good working relationships with both internal and external customers.
ABILITIES
Ability to multi-task in a fast-paced environment.
Must be detailed oriented with strong organizational skills.
Ability to understand patient demographic information and determine insurance eligibility.
Ability to type a minimum of 45 wpm.
ENVIRONMENTAL WORKING CONDITIONS
Normal office environment
PHYSICAL/MENTAL DEMANDS
Requires sitting and standing associated with a normal office environment.
Some bending and stretching are required.
Manual dexterity using a calculator and computer keyboard.
ORGANIZATIONAL REQUIREMENTS
HOPCo Mission, Vision, and Values must be acknowledged and adhered to
This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities, and working conditions may change as needs evolve.
Referral and Authorization Coordinator
Patient service representative job at The CORE Institute
Job Description
Benefits:
Supporting CISH ( Core Institute Specialty Hospital) and Elevation Surgery centers
Competitive Health & Welfare Benefits
Monthly $43 stipend to use toward ancillary benefits
HSA with qualifying HDHP plans with company match
401k plan after 6 months of service with company match (Part-time employees included)
Employee Assistance Program that is available 24/7 to provide support
Employee Appreciation Days
Employee Wellness Events
Minimum Qualifications:
Must have Healthcare experience with Managed Care Insurance, requesting Referrals, Authorizations for Insurance and verifying Insurance benefits.
In-depth knowledge on insurance plan requirements for Medicaid and commercial plans.
Minimum two to three years of experience in a healthcare environment in and prior authorization experience
Essential Functions
Verifies and updates patient registration information in the practice management system.
Obtains benefit verification and necessary authorizations (referrals, precertification) prior to patient arrival for all ambulatory visits, procedures, injections, and radiology services
Uses online, web-based verification systems and reviews real-time eligibility responses to ensure accuracy of insurance eligibility.
Creates appropriate referrals to attach to pending visits.
Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
Completes chart prepping tasks daily to ensure smooth check-in process for the patient and clinic.
Researches all information needed to complete registration process including obtaining information from providers, ancillary services staff and patients.
Fax referral form to providers that do not require any records to be sent.
For primary specialty office visits, fax referral/authorization form to PCPs and insurance companies in a timely fashion.
Reviews and notifies front office staff of outstanding patient balances.
Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue goals.
Respond to In-house provider and support staff questions, requests, and concerns regarding the status of patient referrals, care coordination or follow-up status.
Identifies and communicates trends and/or potential issues to management team.
Index referrals to patient accounts for existing patients.
Create new patient accounts for non-established patients to index referrals.
The job holder must demonstrate current competencies for job position.