Medical Policy Specialist researches and designs criteria to determine policy guidelines used in review of patient cases to ensure only medically appropriate services are reimbursed. Recommends a policy and process that ensure alignment with company guidelines and nationally accepted medical/coding standards. Being a Medical Policy Specialist establishes the proper codes to use for claims processing. Responds to questions from medical staff and communicates details about policy and guidelines. Additionally, Medical Policy Specialist requires a bachelor's degree. Typically reports to a supervisor or manager. Requires Registered Nurse RN. The Medical Policy Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Medical Policy Specialist typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Full-Time, Days
DHR Health
POSITION SUMMARY: The Medical Office Specialist is a key member of the Physician Practice and provides clinical/administrative expertise to ensure all patients receive high quality, efficient care. Team members are responsible to answer phones, register patients, verify insurance and help with billing using their best customer service skills.
POSITION EDUCATION/QUALIFICATIONS: • High School/GED preferred • Excellent customer service skills • Computer skills required with knowledge of Microsoft Office suite • Good written and verbal communication skills required • Bilingual – English/Spanish • Minimum of (2) years receptionist experience preferred. • MOS certificate a plus • Position requires travel, valid license and car insurance, required
RESPONSIBILITIES: • Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices. • Working the reception desk, greeting and communicating with patients and providers. • Scheduling, canceling, and rescheduling patient appointments. • Reminding patients of upcoming appointments and tracking missed appointments, no show and cancellations. • Answering multiple telephones and accurately documenting messages. • Forwarding telephone calls appropriately and following up on return calls. • Checking-in patients and properly documenting registration. • Insurance verification and verification of patient demographics. • Authorizing procedures or surgeries, as needed. • Filing or retrieving medical records and delivering to appropriate providers or departments as needed. • Filing patient and administrative files. • Copying, scanning and faxing duties. • Collecting co-pays and cash from patients, getting authorization on credit cards. • Entering charges, payments, and balancing the day in the computer. • Other duties as assigned
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