Healthcare Operations Specialist

Pennsylvania Medicine Overview
As a leading academic medical center, we strive to provide the highest level of care to patients while conducting innovative research and educating future leaders in medicine.

We are seeking a skilled Clinical Service Specialist to join our team. This individual will play a vital role in providing exceptional patient scheduling, registration, and insurance verification services while ensuring compliance with regulatory requirements.

Key Responsibilities:

• Registration:
• Accurately register patients for appointments, including walk-ins and scheduled visits.
• Process inbound and outbound calls to or from patients, guests, or authorized parties as needed.
• Patient Liability and Point of Service Collections:
• Understand and support point-of-service collections by performing necessary functions to collect patient obligations.
• Refer patients to the appropriate person for questions regarding collections, insurance coverage, and financial assistance.
• E-Health Record Verification:
• Verify patient, guarantor, coverage, and hospital account information.
• Perform required referral authorization processes and enter orders for applicable tests.
• Compliance and Regulatory Requirements:
• Complete documentation for compliance and regulatory needs.
• Retail knowledge and abide by all regulatory requirements pertaining to duties of position and overall operation of the Hospital.

Requirements:

• H.S. Diploma/GED (Required)
• Completion of educational requirements (additional formal education training; maximum supervision for initial competency; high degree associated risk factors; yearly competency evaluation and training). (Required)
• One (1) year prior experience of Revenue Cycle in a Hospital Medical Office Setting AND OR one (1) year administrative data entry experience in a medical facility, health insurance or business setting. (Required)
• One (1) year of clerical, customer service, or administrative support experience in a highly customer-oriented organization. (Required)
• A health care provider in good standing with Medicare, Medicaid, and other federal and state health insurance programs, i.e. not excluded from participation in Medicare, Medicaid or any other federal or state health insurance program. (Required)
• One (1) year of Epic (or equivalent Electronic Medical Record) experience. (Preferred)
• One (1) year of registration experience, point of service collection, insurance validation, understanding of compliance regulatory guidelines and order release process(es). (Preferred)