Patient Visit Specialist - SF

Performs visit closure activities to coordinate patient care while providing an exceptional patient experience for successful completion of next steps ordered by the clinician
Advanced scheduling for specialty or radiologic procedures
Recognizing payor requirements and obtaining prior authorization/certification/referrals for visits/procedures Processes daily referral workqueues for authorization, deferring only those that require payor consideration
Primary Care and most Specialty Care offices must process STAT and ASAP referral workqueues for results received
Return scheduling knowledge to include the ability to scrub schedules for accuracy and efficiency in home department Monitor in-baskets and reports for overdue results, waitlisted appointments, recalls, etc Responsibilities

Work Schedule: Weekday Schedule Monday-Friday

Academic Preparation:

• High school or equivalent
• Short-term training in Medical Terminology
• Familiarity with CPT and ICD-10 coding
  Experience:
• Minimum 18 months experience in a clinical setting with significant MD interaction
• Proficiency in prior authorization/certification/referral process
• Must pass EPIC competency for Registration at completion of Epic Clerical Training class

Professional Requirements:

• Pass annual competency exam for all areas of responsibility.
• Attend Quarterly MSO meetings.
• Attend Staff meetings
• Attend Employee Forums

Abilities:

• Requires strong organizational and multi-tasking skill sets
• Significant customer service skill set paramount
• Must be able to function under pressure while maintaining professionalism
• Working knowledge of CPT and ICD-10 coding
• Pass annual competency exam for all areas of respnsibility.
• Attend Quarterly MSO meetings.
• Attend Staff meetings
• Attend Employee Forums

Education:
Essential:
* High School Diploma or GED

 

 

 

 

Customer Service and Caring Practices:

• Achieve exceptional patient experience for patients and patient families by using CARES, AIDET and EPE tools.
• Addresses and attempts to appropriately resolve complaints in the moment by using key words at key times
• Ability to manage conflict and appropriately request the help of a supervisor when needed
• Fosters effective patient relations with patients, the public and providers by listening, responding and escalating whenappropriate
• Round with patients waiting to insure their comfort and to inform of delays when applicable

Encounter Components:

• Review and follows order entered into the EHR by the clinician
• Schedule return visits lab, radiology, STAT & ASAP appointments and advanced imaging* Obtain Prior Authorization/Referral per payor protocols
• Validates patient MyChart Access
• Prints AVS as applicable with double check for HIPAA privacy
• Collects any backend patient balance such as high deductible
• Communicates effectively to ordering clinician when any restriction, such as access, restricts or prohibits scheduling as ordered

Financial Accountabilities:

 

• Refers as appropriate to on site Financial Advocate, or for uninsured to the Financial Advocacy Center
• Validate prior authorization/certification/referral are secured PRIOR to a scheduled procedure or test, alerting stake holders(patient, patient representative, OR, etc) if a breakdown occurs

Message Management:

 

• Formulates complete and accurate telephone encounter messages and routes to the appropriate Epic in-basket pool to supportoperational aspects of patient care.

Medical Record Components:

• Instructs patients on the Release of Information process and insure a fully completed ROI Form is submitted to Health InformationManagement for incoming or outgoing records

Patient Relations:

• Comprehend quality service connection to patient satisfaction and reimbursement
• Participate in metric goals for telephones performance metrics, TSF and abandonment rate when applicable
• Perform confirmation calls when applicable to include directions and instructions as required by the visit type

Patient Safety:

• Respond quickly to patients showing distress. Follow guidelines set forth by the Clinic Manger to alert the clinical team. Assist inany manner the clinic team directs.
• Ensure check out area, waiting area and walkways are clear of any unnecessary items and are clean and neat.
• Report any concern that may create a safety issue.
• Annual competency completion of Clerical Staff during a Code Blue

Quality Improvement:

• Appointment reminder calls
• Rescheduling
• Evaluate provider schedules and take appropriate action to ensure accuracy and efficiency per guidelines* Works with assigned physicians to maximize schedule effectiveness

C.A.R.E.S Behaviors:

• Demonstrates CARES behaviors of Collaborate, be Accountable, Respect, Engage and Serve to all whom you encounter.Other Information
  Academic Preparation:

We offer more than the standard benefits!

Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!

Learn more about our employee benefits:

https://www.phs.org/careers/why-work-with-us/benefits

Why work at Presbyterian?

As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.

Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.

About Presbyterian Healthcare Services

Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

About Our Regional Delivery System

Presbyterian's Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state's largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities.

We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

About New Mexico

New Mexico continues to grow steadily in population and features a low cost-of living.

Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.

New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

USD $23.07/Hr.

The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.