I. Introduction
A. This position is located at Raleigh Radiology’s Business Support Office location and/or remote.
B. The Patient Benefits Coordinator I is responsible for all revenue cycle tasks that require completion prior to the patient’s date of service. The Patient Benefits Coordinator I will ensure adherence to all Revenue Cycle Management protocols, policies, procedures, and specific instructions.
1) Revenue Cycle Operations
A. Enter new orders from referring providers into the EIS system prioritizing oldest orders in a timely fashion.
B. Work through orders via email, fax, and the document worklist.
C. Enter patient demographics at the highest level of accuracy.
D. Take appropriate measures to always keep Patient Health Information confidential.
E. Contact the referring provider’s office for confirmation when there is any question regarding patient demographics.
F. Ensures that exam type and location are entered accurately.
G. Confirms whether prior authorization is required based on patient’s insurance plan and ordered procedure.
H. Updates status of orders that require prior authorization.
I. Requests medical records/clinical notes from ordering provider when required for obtaining prior authorization.
J. Initiates and Follows-up on prior authorization requests via portal and/or direct phone call to the insurance plan prior authorization department.
K. Meets and/or exceeds daily productivity requirements set by Revenue Cycle Management.
L. Always maintains professional conduct at the highest level.
M. Cooperates and assists management and peers in accomplishment of departmental duties.
2) Other Duties
A. Performs other duties as assigned by Revenue Cycle Management.
I. Education, Experience, Certification, Licensure
A. Education: High School Diploma or equivalent is required.
B. Experience: 1-2 years of experience in a healthcare revenue cycle position is preferred.
II. Desired Skills
A. Advanced knowledge of navigating a patient management system. Data entry skills required. Experience using a soft phone system as well as an electronic fax system. Ability to follow specific directions. Ability to work independently and make sound decisions. Flexibility, dependability, and professionalism are always required. Computer literacy. Must be able to maintain confidentiality of patient health information.
III. Working Conditions / Physical Requirements
A. Prolonged periods sitting at a desk and working on the computer. 100% of work is done at the computer. Ability to type at 60+ words per minute. Must be able to lift 15 pounds at times.
IV. Nature of Supervision
A. Supervised by: Sr. Manager of Operations
B. Supervises: None
C. Instruction / Assistance / Review of Work:
The Patient Benefits Specialist I will function with oversight by the Sr. Manager of Operations, although considerable independent work is required. Daily supervision is directly provided by the Sr. Manager of Operations. Standard Operating Procedures are documented for reference for this position. Orientation and training are provided at hire and on-going as standard operating procedures change. Review of work will occur regularly through an auditing process, as well as daily tracking of productivity. The employee is expected to inform management when unforeseen events/circumstances require significant changes.
