Outpatient Consultation Representative

Kern Medical has been a community cornerstone since its founding in 1867. Today, we are an acute care teaching center with 222 beds, offering the only advanced trauma care between Fresno and Los Angeles. Kern Medical cares for 15,500 inpatients and 125,000 clinic patients a year.

Career Opportunities within Kern Medical include many benefits such as:

• New Hire Premium: +6% of base rate of pay, matched up to 6% if contributed to Deferred Compensation Plan.
• A Comprehensive Benefits Package: includes Holidays, Paid Time Off, Retirement, Medical, Dental, Vision and Life Insurance.

Position: Outpatient Consult Representative - Full time - Outpatient Scheduling and Authorization

Compensation

The estimated pay for this position is $23.0617 to $28.3630. The rates shown include a 6% premium pay (base= $-$ plus 6%). This reflects only a portion of the total compensation package for this position. Additional compensation may be available for this role through differentials, incentives, and bonuses. In addition, this position may be eligible for participation and company contributions into the Kern County Employees’ Retirement Plan.

Job Description

Under supervision, submits required necessary documentation to insurance companies in order to obtain required prior authorization for patient care and/or treatment in addition to performing basic registration functions for the capture of pertinent demographic and insurance/payer information as well as scheduling activities, which may include: basic patient registration knowledge in order to effectively schedule appointments which will result in billable charges, collecting and entering accurate patient demographic information, selecting correct patient account information, validating necessity of authorization(s) for specific appointment types being booked and scheduled.

DISTINGUISHING CHARACTERISTICS:

Incumbents have hospital/healthcare knowledge or experience, and are expected to gain specific knowledge of the importance of patient and insurance demographic information and the availability of payment options for patients requiring a referral to a financial counselor. Outpatient Consult Representatives will be responsible for prioritizing notifications received for pending consults, processing consults timely, ensuring that patient insurance information is accurate and that authorizations are in line with coordinated benefits, as well as utilizing all resources available to obtain swift approvals to ensure patient safety and continuity of care. Outpatient Consult Representatives will additionally be responsible for answering phones, directing patient calls to the appropriate departments when necessary and scheduling appointments for multiple different physicians, providers, specialties, clinics, and locations.

Essential Functions:

• Submits necessary documentation to insurance companies in order to obtain required prior authorization for patient care and/or treatment.
• Tracks and follows up on outstanding requests for authorization.
• Answers patient phone calls, reviews process, and schedules appointments for exam or follow up.
• Enters all patient demographic information into electronic patient record system; uses other department applications for eligibility and authorization.
• Screens referrals and informs referring physician offices, patients and their families about hospital policies and procedures regarding method of payment sources for services rendered.
• Documents funding information from patients and provides information on available funding resources; refers patients to financial counselors when funding is not in place.
• Uses payer resources and websites to explore and assess eligibility.
• Assist with training of staff members.
• Works in collaboration with outpatient scheduling and registration to identify and resolve issues and/or barriers.
• Submits and responds to requests for information and inquiries related to outpatient authorization/scheduling processes, policies, and/or other related information; researches and resolves customer problems.

OTHER FUNCTIONS

• Performs other job-related duties as required.

Employment Standards:

• High School Diploma, G.E.D. or equivalent;

• One (1) year of outpatient clinic or medical office experience performing scheduling and/or authorizations OR an equivalent combination of education, training, or experience sufficient to successfully perform the essential duties of the job.

Candidates must provide detailed information on their equivalent combination of education and/or experience which provides the knowledge of and abilities indicated below:

Knowledge of:

• State and federal government funding programs such as Medicare, Medi-Cal, CCS, TRICARE/CHAMPUS, Workers’ Compensation, and commercial insurance payers;
• Billing and reimbursement guidelines and methodologies for state and federal government and non-government payers;
• Medical and insurance terminology;
• HIPAA privacy and compliance practices.

Ability to:

• Communicate effectively both orally and in writing sufficient to perform the essential functions;
• Read, understand, and apply policies and guidelines;
• Obtain information from a variety of sources, including patients and families;
• Use computers and various software to accomplish work;
• Establish and maintain effective working relationships with patients, families, and other internal and external customers;
• Use tact and empathy in working with patients and families under stressful situations;
• Perform work effectively with frequent interruptions;
• Perform multiple tasks in a fast paced environment; lift, carry, push or pull files;
• Sit at work station for prolonged periods of time.

SUPPLEMENTAL:

• Employees must maintain all health requirements designated by Kern Medical;
• Depending on assignment incumbents may be required to possess and maintain specific certificates of competency as a condition of employment;
• A background check may be required for this classification;

All Kern Medical employees are designated “Disaster Service Workers”. In the event of a disaster or civil disorder, all Kern Medical employees are to remain at work or to report to work in a safe and practicable manner.

Experience

Preferred

• 1 year(s): One (1) year of outpatient clinic or medical office experience performing scheduling and/or authorizations OR an equivalent combination of education, training, or experience sufficient to successfully perform the essential duties of the job.

Education

Required

• High School or better

Behaviors

Preferred

• Team Player: Works well as a member of a group

Motivations

Preferred

• Self-Starter: Inspired to perform without outside help

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.