Job Description

POSITION SUMMARY

Act as a liaison between NMO and workers’ compensation customers (adjusters, case managers, referring physicians, attorneys, patients). Ensure quality service to customers while verifying coverage of benefits and providing requested information to clients.

ESSENTIAL RESPONSIBILITIES:

  • Plans and directs pre-verification of patient insurance, billing and collections and data processing to ensure accurate patient billing and efficient account collection.
  • Act as liaison between WC representatives and office staff involving authorizations for all procedures and diagnostic tests ordered by NMO physicians. Involves faxing orders and documentation and notifying staff of authorizations or denials.
  • Sends patient progress notes and work status form to workers’ compensation carrier and case manager when required.
  • Schedules, books, coordinates and reschedules new and existing patient appointments.
  • Answers telephone, screens calls, takes messages when necessary.
  • Updates patient records when necessary.
  • Obtains authorization for diagnostic tests and surgeries.
  • Assists in keeping workers’ compensation carrier contact list current.
  • Verifies workers’ compensation insurance coverage for all assigned patients and obtains pre-cert requirements.
  • Obtains authorizations prior to visit.
  • Verifies all authorizations are current and updates patients account information with current authorization.
  • Maintains bump list ensuring patients and Case Managers are notified of bumped appointments.
  • Adheres to company policies as described in employment handbook and company work rules
  • Participates in professional development activities and opportunities.
  • Maintains confidentiality of patient account information in accordance with HIPAA guidelines and NMOA policy.
  • Regular and reliable attendance
  • Performs any other duties as assigned.

SUPERVISORY RESPONSIBILITIES: N/A

KNOWLEDGE, SKILLS AND ABILITIES:

To perform this job successfully, an individual must be able to perform each essential responsibility satisfactorily. The requirements listed below are representative of the knowledge, skills and/or abilities required.

  • Exceptional customer service skills.
  • Knowledge of current basic medical terminology, coding, eligibility and prior authorization knowledge and office procedures.
  • Strong computer and phone skills.
  • Ability to establish and maintain effecting working relationships with staff, co-workers, patients and vendors.
  • Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, decimals and percentages.
  • Ability to understand, read, write and speak English; Spanish speaking preferred.
  • Ability to read, analyze and interpret medical information, technical procedures and/or general business information.
  • Ability to effectively present information, respond to questions and professionally interact with physicians, managers, employees, patients, vendors and the general public.
  • Ability to recognize and define problems, collect data, establish facts, draw conclusions and correct errors.
  • Ability to interpret a variety of instructions in a variety of forms and deal with abstract and concrete variables.
  • Ability to handle multiple simultaneous tasks effectively and efficiently while maintaining a professional, courteous manner.
  • Exhibit understanding of healthcare regulatory and compliance policy (e.g., HIPAA).
  • Knowledge of New Mexico Worker’s Compensation procedures and NMO policies and procedures.
  • Requires ability to identify and implement opportunities to improve performance of the department.
  • High integrity, including maintenance of confidential information.
  • Ability to exercise good judgment and positively influence others, including handling confrontations with poise and efficiency.

EDUCATION AND/OR EXPERIENCE: 

High School Diploma or GED and two years of relevant experience. Pre-verification and medical scheduling experience in a medical office setting preferred.

CERTIFICATIONS, LICENSES, REGISTRATIONS:

None required

PHYSICAL DEMANDS AND WORK ENVIRONMENT:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job responsibilities.

While performing the duties of this job, the employee is occasionally required to stand; walk; sit for extended periods of time; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, bend, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 20 pounds. Repetitive motion of upper body required for extended use of computer. Requires vision correctable to 20/20 and hearing in the normal range for face-to-face and telephone contacts.

Works in well-lit, ventilated and climate controlled office environment with routine office equipment; some equipment has moving mechanical parts.

Noise level in the work environment is usually moderate.