Prior Authorization Associate Jobs in California

Job Summary
Reporting to the clinic operations manager and the site nurse, the medical assistant adeptly multitasks to fulfill various responsibilities including scheduling appointments, registering patients, collecting co-pays, recording pertinent patient data in the electronic health record (EHR) system, and ensuring a safe and sanitized environment. Moreover, they serve as a crucial communication nexus within the medical practice, demonstrating exceptional multitasking capabilities and outstanding customer service in all interactions.
Duties/Responsibilities: Core
• Maintains courteous, professional relationships with providers, patients, families, peers, healthcare team members, and external agencies.
• Answers the telephone properly using department name and personal first name slowly and clearly. Records and delivers messages accurately in the EHR system and in a timely manner to staff and providers.
• Is knowledgeable in the use of PC and applications specific to the department. Demonstrates ability to use current EHR technology and information systems to enhance data collection and documentation.
• Competent in the use of systems designed to check insurance eligibility and benefits and downtime procedures if the computer systems are not operating correctly.
• Verifies accuracy of patient and insurance information upon scheduling appointment and registering patient into the clinic for treatment. Verifies insurance coverage of the clinic visit and any co-pay or deductible needing to be collected. If prior authorization is required, verifies that the prior authorization is in the chart prior to the patient visit.
• Properly opens/closes cash drawer to accept payments and co-pays, accurately completes deposit, credit card transactions, printing of records and posting payments into the Meditech system. Follows established hospital policy for handling cash and collecting money for co-pays and deductibles.
• Knowledge of all programs offered by the various clinics as well as what insurances are accepted by the clinics. Demonstrates knowledge of appropriate incoming referrals, internal and external referrals, enrollment requirements, and program coverage to the special clinic programs. Examples of programs; Child Health and Disability Program (CHDP), Connect to Care, Medi-Cal, various Medi-Cal coverage programs, limited scope Medi-Cal, commercial insurance, San Benito Medical Associates (SBMA), Every Woman Counts (EWC), Family Pact and Comprehensive Perinatal Services Program (CPSP).
• Schedules new, established, well women exams, CPSP, well child exams, pre-op and post op appointments, same day and emergency room follow-up appointments for office visits and using the appropriate and established appointment timeframes and providers.
• Demonstrates procedure for scheduling patients for outpatient services, coordinates resources, and gives correct instructions of the process for completing pre-registration to attending the appointment.
• Has knowledge of Workers' Compensation processes and the information required to schedule the patient appropriately (required authorizations, creating and updating PR-2's) and knows requirements for PR-4 exams.
• Demonstrates knowledge of proper procedure for obtaining medical records from outside agencies or providers, completing proper paperwork and following through verifying that records are received.
• Proficient in healthcare quality program(s) and is well-versed on processes for patient scheduling.
• Reviews patient encounters and compares provider note, lab tests ordered and supplies distributed to patients, to the superbill to ensure all charges are captured. Enters charges into the Meditech system daily.
• Adheres to established hospital procedures for maintain patient clinical records within the EHR system as mandated by regulatory agencies, including proper downtime clinic procedures with appropriate forms, upholds HIPAA standards for privacy and confidentiality in accessing patient health records, utilizing break the glass option, and acknowledges potential disciplinary actions for inappropriate record access.
• Demonstrates adherence to expected productivity standards by promptly reporting any variances to the supervisor, including instances of overtime, incomplete tasks, or patient care issues.
• Communicates the status of office patient flow and any issues, any delays/changes to patients that may affect their appointment time or duration with the supervising nurse and providers'.
• Demonstrates process for in-house referrals through EHR system and documents appropriately in the patients chart the outcome of contacting the patient regarding appointment details.
• Tracks outgoing referral with the site nurse's direction to ensure appointments are attended by patient and consult notes are received from the specialist.
• Communicates to all referring providers by faxing patient visit note and procedure documents in a timely manner within 24 hours of chart completion.
• Sends out all written communication to notify patients of appointments and follow up care needed.
• Completes all necessary forms patients require, including EDD, FMLA, Workers' Compensation, supplemental insurance forms, etc. and assures provider portions are addressed.
• Demonstrates ability to scan patient information and place in appropriate folder within the EMR and label correctly with title of scanned document.
• Demonstrates proper procedure for assigning incoming faxes in the EHR systems' "inbox" to the appropriate staff/provider for review.
• Ensures that all recently ordered lab, diagnostic imaging, physician consults, and other testing results are available for the provider to review at the time of patient visit.
• Tracks all pathology, labs, and imaging tests ordered by provider to assure patient compliance. Conducts follow-up on any provider/site nurse recommendations for future care.
• Maintains orderly and cleanliness of patient waiting area.
• Maintains inventory of front office supplies. Orders inventory from Purchasing as needed.
• Places the patients in the exam room ensuring they are as comfortable as possible, explains the appointment process to the patient and what to expect from their visit.
• Has knowledge of what can be an urgent issue and when to notify the site nurse or provider immediately.
• Ensures through cleaning and restocking of treatment rooms and equipment prior to each patient visit, maintaining a hygienic and well-prepared environment for their treatment.
• Demonstrates correct use of clinic equipment i.e. exam tables, exam lights, special procedures trays, vital sign machine, pulse oximetry, patient scales.
• Maintains inventory of back office clinical supplies, rotates stock, and checks for outdated supplies. Orders inventory from Purchasing as needed.
• Performs patient intake by reviewing medication lists, allergies, documenting vital signs, social history, patient chief complaint and any other pertinent information required by provider accurately in the EHR system prior to provider entering the patient room. Prepares patient, assists providers with examination and treatment of patients, and is accessible to them.
• Assists providers with in-office medical procedures at the bedside.
• Performs suture and staple removal, as directed by provider.
• Has knowledge of post-operative complications and knowledge of what can be an urgent issue and when to notify the site nurse or provider immediately.
• Demonstrates proper use of Language Line services.
• If staff member provides translation services, medical terms, procedures, instructions, examinations procedures and findings, and all other communication is translated correctly and patients understand what is being translated.
• Conducts CLIA waived laboratory tests as ordered by the provider, following hospital and CLIA lab policies and procedures. Completes annual lab competencies as assigned by the hospital laboratory, ensuring accurate documentation of in-house CLIA waived lab testing and results in the EHR system.
• Demonstrates proper specimen handling, labeling, and transportation techniques.
• All other clinical and non-clinical duties as assigned within their scope of practice.
Duties/Responsibilities: OB/ GYN
• Coordinates appointment schedule using established obstetrics and gynecology priorities.
• Performs and documents appropriately the following scheduling scenarios applied to gynecology versus obstetric patient:
o Patient cancellation
o No-show appointment
o Rescheduled appointment
• Scheduling for multiple providers, appointment times and durations for a variety of OB/GYN procedures, patient education and exams.
o Non-stress testing, nutritional education, ultrasounds in clinic vs. hospital, Comprehensive Perinatal Services Program (CPSP), Lactation, Birthing Center, Specialists, etc.
• Working knowledge of different insurances: how and when to register the patient for different programs, ability to verify insurance, services covered by the different programs, and requirements for each of the programs below:
o Hollister Multi-Specialty
§ Commercial Insurance
§ Self-pay
o Mabie 4th Street
§ Pregnancy related Medi-Cal
§ Comprehensive Perinatal Services Program (CPSP)
§ Medi-Cal, Medi-Cal Anthem Blue Cross, San Benito Medical Associates (SBMA) Medi-Cal
§ BCEDP, Early Cancer Detection Program
§ Family Pact
§ Share of Cost
• Demonstrates knowledge of navigating the pregnancy note (ACOG) to gather information, send medical records and find information needed by the providers.
• Prepares and assists provider with minor in-office OB-GYN procedures as the bedside (refer to specific OB/GYN competencies).
• Prepares each patient's EHR for OB/GYN surgeons and adequately schedules cases with OB and surgery departments. Coordinates surgical assist as needed and directed by site nurse/provider.
• Adequately explains simple registration process for C-sections, scheduled surgeries and procedures.
• Serves as a resource to all of the OB/GYN providers when needed..
Required Skills/Abilities
• Takes personal responsibility for the quality and timeliness of work to be completed.
• Demonstrates the ability to problem solve and/or assist with problem solving.
• Earns others trust and respect through consistent honesty and professionalism in all interactions.
• Follows through on suggestions and request; appreciates positive suggestions for improvement.
• Maintains composure in highly stressful or adverse situations.
• Performs tasks with care and makes few, if any errors.
• Promotes cooperation and commitment within a team and with patient care to achieve goals and deliverables.
• Mentor, train, and provide ongoing guidance to new staff members, ensuring proficiency in their roles, familiarity with office procedures, and promoting a positive and collaborative work environment helping co-workers to grow and succeed through feedback and positive encouragement.
• Demonstrates flexibility and adaptability by being able to float and provide coverage for other clerks in the clinic setting when needed, such as during sick leave or vacation time, ensuring uninterrupted clinic operations.
• Responds positively to change, embracing and using new practices to accomplish goals.
• Efficiently handles multiple tasks upon patient arrival. Facilitating workflows between front and back office.
• Mindful of the signals conveyed through non-verbal cues, including tone, posture, and eye contact in communication.
• Adheres to a standard of professionalism and courtesy at all times, fostering positive rapport and collaborative working relationships with providers, referral sources, patients/families, staff, and peers.
• Excellent attendance record and is punctual for all shifts scheduled.
• Adheres to hospital and department dress code, appearance is neat and clean, identification is worn at all times above the waist.
• Maintains patient confidentiality at all times in compliance with HIPAA Standards.
• Completes annual educational and Employee Health requirements.
• EKG competency completed after orientation.
• Attends meetings as appropriate or directed.
• Ensures compliance with Regulatory Standards including but not limited to hospital and department specific policies and procedures, fire, safety, infection control, OSHA, Federal, State, Title 22 and The Joint Commission (TJC).
• Reviews and complies with all new and revised department and hospital polices.
• Displays proficiency in accessing electronic, hospital-wide policy manual and Safety Data Sheets (SDS).
• Promotes and adheres to established SBHC Core Values & Standards of Behavior communicating and representing the organizations Mission, Values, and Vision in a positive and professional manner in the department and community.
• Adherence to all organizational policies encompassing ethical business practices, standards of behavior, harassment, attendance, and safety. Demonstrates competence in fulfilling duties and responsibilities aligned with the San Benito Health Care District's Corporate Compliance Program.
Education & Experience
• Completion of a Certified Medical Assistant Program required.
• High school graduate or equivalent.
• One (1) year experience in a medical office as a Medical Assistant highly preferred.
• Current BLS Certification by American Heart Association or American Red Cross.
• Bilingual in English and Spanish speaking and writing preferred.
• EKG competency completed upon hire.
• Basic math, money handling, and accounting skills; knowledge of medical terminology; and health care insurance billing.
Job Type: Per Diem, Variable Shifts
Pay: $30-$41/hour
Benefits:

• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Ability to Commute:

• Hollister, CA 95023 (Required)

Alternatively, you may submit your completed application directly to apply.jobs@hazelhawkins.com.
You can access the application form here: https://www.hazelhawkins