I. Basic Purpose:
SRA Agent is responsible for managing all aspects of the referral lifecycle and patient scheduling for physician offices supported by TCIH. Knowledge of current payer requirements and network guidelines must be maintained to facilitate verification of service coverage. Serves as an ambassador for network and creates peace of mind by demonstrating an efficient, caring, trustworthy and professional behavior at all times.
II. Major Duties and Responsibilities:
1. Complies with established corporate and departmental policies, procedures, objectives, quality assurance methods, and safety codes. Demonstrates compliance with licensing, regulatory and accrediting agency provisions as required.
2. Consistently demonstrates appropriate and professional communication behavior toward patients, customers, and coworkers. Cooperates with Management and peers to promote an environment of teamwork and collaboration.
3. Reviews and enters all applicable information, verifies patient demographics, and completes all applicable tasks to complete referrals, obtain authorizations, schedule patients, and communicate follow-ups in accordance with TCIH, SRA department, and other associated regulatory guidelines and standards..
4. Monitor all referrals for completion, including scheduling, authorization and results received. Ensures consult notes and test results are received and attached correctly to facilitate appropriate routing to ordering provider for review.
5. Verifies patient eligibility with payer source and obtains authorization per requirements. Contacts insurance or payers, interviews patient, obtains and verifies authorizations for visits and services. Provides clinical support to insurance or payers as requested.
6. Communicates pertinent scheduling, referral, authorization information with patient via phone, MyChart, mail or other modes of communication deemed appropriate maintaining professionalism, courtesy and conciseness. Responds to all incoming patient requests timely and efficiently.
7. Monitors all work queues, phone calls and in-basket messages and responds professionally and accurately, in a timely manner
8. Efficiently and effectively prioritize and escalate issues to direct leader according to patient needs while ensuring complete and accurate collection of all necessary information to fulfill needs of client or patient.
9. Adheres to all corporate and departmental policies, procedures and standard work in completing all assigned tasks and duties. Maintains awareness and understanding of individual and department performance measures and embraces improvement efforts and changes to continually meet performance goals.
10. Demonstrates compliance with licensing, regulatory and accrediting agency provisions as required.
11. Consistently demonstrates appropriate and professional behavior that is indicative of ICare values, including supporting peer development and cross-training efforts
12. Exhibits professional work habits such as keeping area neat and organized.
13. Enhances professional growth and development through participation in cross-training opportunities, educational programs, in-service meetings as they are available.
14. Attends and participates in all meetings, daily huddles, seminars and in-service training as required.
15. Maintains annual mandatory education requirements specific to position as mandated by Treasure Coast Integrated Health and Martin Health System.
16. Performs all other duties as assigned or requested.
17. Maintains annual mandatory education requirements specific to position as mandated by Martin Health System.
18. Performs all other duties as assigned or requested.
III. Minimum Requirements (experience, training, and education):
To effectively fulfill this position, candidate must meet the following requirements:
> Education: High school diploma or equivalent education; additional courses in business office practices preferred.
> Experience: Related experience with clinical referrals or coding in a clinical environment preferred
> Skills: Computer literacy and comfort with various technology platforms; medical terminology; knowledge of basic anatomy; working knowledge of coding principles; exceptional communication skills for interaction and negotiations with payers, providers and patients; data entry skills and familiarity with EMR
> Abilities: Ability to organize, analyze and prioritize work; function in a high volume / fast paced environment, communicate well with others in a prompt, efficient and accurate manner; work effectively with a multidisciplinary team;
The policy of Cleveland Clinic and its system hospitals (Cleveland Clinic) is to provide equal opportunity to all of our employees and applicants for employment in our tobacco free and drug free environment. All offers of employment are followed by testing for controlled substance and nicotine. Job offers will be rescinded for candidates for employment who test positive for nicotine. Candidates for employment who are impacted by Cleveland Clinic’s Smoking Policy will be permitted to reapply for open positions after 90 days. Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic facility.
Cleveland Clinic is pleased to be an equal employment employer: Women/Minorities/Veterans/Individuals with Disabilities