Doctor Staffing Coordinator

Summary: 

• Staffs a minimum of 20 files weekly by accessing the Preferred Provider Network and out-of-network providers, if necessary.

Duties and Responsibilities:  

• Selects and schedules new and pending files with the appropriate medical provider.
• Takes new referrals as they are called in for both doctor and dental files quickly and efficiently.  
• Enters referral into proprietary software, SMILES.
• Obtains previous medical records from provider's office or insurance carrier.
• Sends appropriate provider packet prior to scheduled appointment.
• Obtains payor authorization for new evaluations.
• Requests billing information from provider and ensures proper codes are utilized.
• Communicates expectations effectively with provider until evaluation is scheduled.  
• Communicates with Nurse Case Manager / Adjuster daily until evaluation is scheduled.
• Works with non-contracted providers to coordinate and schedule appointments when contracted providers are not available.
• Explains applicable state forms to provider office.
• Follows up on all assigned files daily.
• Consistently demonstrates a positive attitude, dependability and an overall commitment to excellence and is a team player.
• Actively participates in continuous operational improvements. Specific activities include, but are not limited to, offering feedback to management related to process, working closely with provider development team to address provider issues, collaborating with financial team to improve efficiency and participates in training/mentorship initiatives
• Is open to coaching and willing to find more efficient processes when applicable.
• Performs miscellaneous tasks and projects as assigned by management.
• Other duties may be assigned.

Qualifications:

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  
• The requirements listed below are representative of the knowledge, skill, and/or ability required.  
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Language Ability:

• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. 
• Ability to write routine reports and correspondence. 
• Ability to speak effectively before groups of customers or employees of organization.

Math Ability:

• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. 
• Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Reasoning Ability:

• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. 
• Ability to deal with problems involving several concrete variables in standardized situations.

Computer Skills:
To perform this job successfully, an individual should have knowledge of:

• Microsoft Word
• Microsoft Works
• Microsoft Excel
• Microsoft Outlook
• Internet Explorer
• Smiles proprietary software

Education/Experience:

• Associates Degree from two-year college or university; or one to two years related experience and/or training; or equivalent combination of education and experience.  
• Medical Assistant License or Certified Nursing Assistant License Preferred.

Physical Demands:

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit; use hands and talk or hear. 

• The employee is frequently required to reach with hands and arms. 
• The employee is occasionally required to stand and walk. 
• The employee must occasionally lift and/or move up to 15 pounds. 

Work Environment:

• The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• The noise level in the work environment is usually moderate.