Clinical Representative

Department: CONTACT CENTER Experience: 2 YearsDeadline: February 07, 2025Location: Rawalpindi, Pakistan

Job Profile

• Verification and Approval
  • Contact insurance providers to verify coverage and determine if prior authorization is needed.
  • Submit authorization requests and follow up until approval is obtained.
  • Maintain accurate records of all interactions with insurance providers.

• Documentation
  • Update patient records with authorization details.
  • Ensure all documentation complies with HIPAA and other privacy regulations.

• Communication
  • Notify healthcare providers and patients about authorization status.
  • Escalate any delays or issues to the relevant team members.

• Calendar Management
  • Schedule appointments for patients based on provider availability and patient preferences.
  • Coordinate rescheduling or cancellations promptly.

• Patient Communication
  • Confirm appointments via phone, email, or text reminders.
  • Provide pre-appointment instructions or location details.

• System Updates
  • Update schedules in EHR (Electronic Health Records) systems or scheduling software.
  • Resolve scheduling conflicts by coordinating with the team.

• Coordination
  • Process patient referrals by contacting specialists or other healthcare facilities.
  • Ensure referrals are sent and received within the required timeframe.

• Verification
  • Confirm referral requirements with insurance providers and verify coverage.
  • Follow up with referral facilities to ensure appointments are scheduled.

• Record Maintenance
  • Update patient records with referral details and communication logs.
  • Track referral status and notify the team of any issues.

Tools / Skills

• Technical Skills
  • Experience with EHR/EMR systems.
  • Familiarity with insurance verification portals and tools like Availity or NaviNet.
  • Proficiency in calendar management software Microsoft Outlook.

• Soft Skills
  • Strong organizational and multitasking abilities.
  • Excellent communication skills (verbal and written).
  • Problem-solving and conflict-resolution capabilities.

• Knowledge of Insurance and Healthcare Processes
  • Understanding of insurance authorization workflows.
  • Awareness of HIPAA compliance and confidentiality requirements.

Additional Information