Medical Office Specialist, Primary Care

Responsible for ensuring efficient administrative operations in coordination with leadership. Responsible for obtaining approval of professional and technical services, which may include obtaining insurance referrals, procedure authorizations, or pre-certifications required for patients to receive physician services, medical procedures, equipment, supplies, and medications.

• Demonstrates exceptional customer service both for in-person and telephone activities.
• Greets patients and visitors, as well as other customers, pleasantly and courteously in person and/or via phone call.
• Maintains privacy during all interactions, including check-in.
• Demonstrates ownership of own role in the customer experience and describes the impact their performance has on the overall patient satisfaction.
• Prioritizes tasks to meet customer needs.
• Optimizes listening skills to best address customer requests and needs.
• Projects a professional image in appearance, demeanor, communication, and behavior.
• Updates and engages patients/family if there are delays with the patient's experience as per department standards.
• Answers telephones calls as per department standards.
• Schedules and coordinates appointments with the correct provider using all appropriate information.
• Utilizes existing decision based tools to facilitate securing the right appointment with the right medical provider or team.
• Maintains competence in use of scheduling and web applications.
• Schedules appointments appropriately and correctly, including right patient, right provider, right amount of time, right type of visit, right information, and using the right process.
• Requests records and/or sends to Health Information Services in a timely manner.
• Obtains required demographic and insurance information and loads or verifies for each appointment scheduled.
• Accurately completes required tasks and fields in pre-registration.
• Creates patient "no show" and "cancellation" letters according to office policy. Calls to reschedule as appropriate.
• Performs verification functions.
• Obtains two patient identifiers consistently.
• Verifies patient legal name including spelling before creating a new MRN.
• Verifies PCP and adds clinic provider when appropriate.
• Updates or adds insurance information, including payer and subscriber when scheduling.
• Correctly identifies the referring provider.
• Collects payments and credits the correct account.
• Prepares, verifies, and reconciles deposits daily per current policy.
• Determines need for insurance referral prior to the visit and obtains as necessary.
• Obtains waiver prior to service when an insurance referral is denied.
• Demonstrates expected behaviors applicable to UPG; scheduling and registration system; and unit policies, procedures, and guidelines.
• Utilizes electronic medical record functionality (e.g., inbox, telephone encounters, prescription requests, pools, letters, and documentation only) per department process guidelines.
• Registration elements, including Medicare Secondary Payer Questionnaire (MSPQ), scanning of long-term signatures (LTS) and insurance cards, Advanced Beneficiary Notices (ABNs), waivers, and financial screenings are completed when indicated and in a timely manner.
• Demonstrates effective and accurate scheduling maintenance skills, including following established processes including format and timelines.
• Collaborates with appropriate help chain (e.g., supervisor/manager) to review requested schedule changes to ensure they meet clinic needs.
• Uses the patient tracking system for the clinic correctly and in a timely manner.
• Achieves expected metric targets applicable to schegistration.
• Performs visit document activities in an accurate and timely manner.
• Obtains records and ensures they are available for the visit.
• Completes clinic chart prep procedures in an accurate and timely manner.
• Prints medication lists and gives to the patient/family for review during check-in.
• Prints the after-visit summary and gives to the patient prior to departure.
• Ensures that documents provided are approved, professional in appearance, and current.
• Ensures that documents sent to Health Information Services are appropriate and correctly labeled.
• Ensures that appropriate blocking and unblocking of schedules is handled per department procedure.
• Demonstrates engagement in the work, team, and goals of the clinic.
• Describes individual role and how it affects and enhances the work of the group.
• Actions are supportive and meet or exceed patient/family/co-worker expectations by implementing the ASPIRE concept.
• Accepts personal responsibility for role in patient satisfaction outcomes and demonstrates behaviors that promote improvement.
• Willingly takes on or assists with other tasks as needed or requested, completing them in an accurate and timely manner.
• Other projects and/or assignments as directed.
• Obtains referrals, authorizations, and pre-certifications through a work queue process flow and Epic lists to ensure required approvals are obtained within an established time standard.
• Reviews and evaluates documentation of electronic medical records (EMR) to obtain medical necessity and clinical data for approvals.
• Ensures referrals are attached to appointments and the appropriate insurance information is documented. Researches and updates insurance carrier requirements as necessary.
• Assesses the documentation to assign appropriate CPT procedure and ICD code to accurately report the physician services.
• Collaborates with referring and/or ordering provider across UVA departments to obtain information to support medical necessity and accurate coding.
• Coordinates appointment and authorization information to in- and out-of-network entities that provide care, to include hospital systems, clinics, specialists, equipment suppliers, manufacturers, and pharmacies.
• Communicates and coordinates with patient the scheduling of diagnostic and specialty appointments, tests, procedures, insurance coverage, and patient financial responsibility. Obtains as necessary waivers for non-covered services. Reviews financial assistance options as applicable.
• Documents in EMR all required and support information to ensure providers, insurance companies, pharmacies, and staff have appropriate information to approve, provide care, and perform accurate billing.
• Collaborates with ordering provider, manager, and staff to address denied authorizations. Facilitates discussion between provider and insurance company of request to change orders, appeal process, and peer-to-peer review. Completes form or electronic process for appealing denials per payer guidelines.
• Manages verbal, electronic, and written inquiries from pharmacists and providers regarding authorizations for prescribed medication.
• Facilitates resolution of medication coverage issues and proactively addresses, researches, and resolves issues, to include early release, quantity and dosage, generic equivalent, and treatment options.

MINIMUM REQUIREMENTS

• Education: High school diploma or GED.
• Experience: Three years of relevant experience required. Customer service experience required.
• Licensure: None.
• Skills: Basic knowledge of and experience utilizing a personal computer. Basic word processing skills required. Must have ability to learn and use telephone, facsimile, and copy machine systems. Understanding of human anatomy, medical terminology, and procedures required. Strong computer skills, including use of Microsoft Office (Word and Excel), electronic mail, and EMR required. Strong analytical, prioritization, and organizational skills required.

PHYSICAL DEMANDS
Busy medical office environment. Daily work is accomplished with minimal direct supervision. Physical activity may include the ability to lift/push/pull 20-50 pounds, and would involve standing for prolonged periods of time, as well as frequently bending/stooping and walking. Physical hazards include potential exposure to body fluids and associated pathogens/infectious disease, as well as potential exposure to chemicals.

COVID Vaccination Requirement and Guidelines

Please visit the UVA COVID-19 Job Requirements and Guidelines webpage prior to applying for current information regarding vaccination requirements and guidelines for employment at UVA.