ABOUT THE HSC HEALTH CARE SYSTEM

The HSC Health Care System is a nonprofit organization combining the resources of a care coordination plan; (Health Services for Children with Special Needs, Inc.), pediatric specialty hospital (The HSC Pediatric Center), home health agency (HSC Home Care, LLC), and parent foundation (The HSC Foundation) to offer a comprehensive approach to caring, serving and empowering people with disabilities. The HSC team of 750 employees and more than 100 volunteers together serve children and young adults with special health care needs and their families at our District of Columbia and Maryland locations.

ESSENTIAL HSC MISSION AND VALUES

Mission Statement
HSC Health Care System provides and coordinates innovative, high quality, community-based care for individuals with complex needs and their families. HSC empowers all we serve to improve the quality of their lives.

Organizational Beliefs
HSC supports individuals and families to maximize their potential. The following beliefs drive our work. HSC believes that:
- A culturally diverse community is a strength.
- Inclusiveness for individuals, families, and staff promotes positive outcomes.
- Everyone should be treated with compassion and empathy.
- Our skillful, dedicated, and resourceful staff is key to our success.
- We must continually adapt to the changing needs of our community.
- Increased independence is an important goal for individuals and their families.

POSITION SUMMARY

Coordinate the entry into the HSC system by registering and scheduling patients for therapy and clinic appointments. Manage incoming referrals and add to waitlist when appropriate. Responsible for collecting demographic, financial and clinical information and acquiring insurance authorization. Monitor insurance authorizations throughout treatment plan to reduce insurance denials. Serve as a liaison between patient and family, clinic and providers. Perform responsibilities within established customer service standards.

Minimum Education
High School Diploma or GED (Required)

Minimum Work Experience
2 years of prior clerical experience in a health care environment. (Required)

Required Skills/Knowledge
Medical Terminology use and understanding is required, CPT/ICD Coding is preferred.
Working knowledge of medical and private insurance authorizations and procedures.
Proficient with hospital computer programs.
Insurance Terminology use and understanding.
Professional telephone manners
Strong organizational skills
Knowledge/experience of computer systems including, but not limited to, Windows, Microsoft Outlook, Excel and Word programs.
Ability to prioritize and manage multiple tasks with efficiency.
Perform other duties as required including cross training for patient registration.
Demonstrate working knowledge of SharePoint, Cerner and eClinical Works (eCW) or other EMR.

Job Functions
Registration and Scheduling

• Maintain referrals and appointment requests (fax queues, email requests, etc.) and add to waitlist.

• Obtain physician orders for services to be provided, as needed.

• Using Automated Call Distribution (ACD) establish contact with patients via inbound and outbound calls to pre-register patients for future dates of service.

• Schedule all appointments and provide accurate schedule updates to supervisor as per established productivity guidelines for program including AT (full team evaluations, AAC evaluations and trainings, power mobility evaluations and trainings), OPED (DME/orthotics), serial casting, UE/LE custom splinting, OT, PT and ST, and feeding and swallowing clinic appointments.

• Manage and maintain schedules for all vendors/orthotists/therapists/licensed practitioners and distribute schedules accordingly.

• Disseminate and/or complete pre appointment paperwork or online forms (consents, screening tools) with family during scheduling call.

Eligibility and Authorizations

• Collect and review clinical documentation to ensure that information supports appointment request.

• Provide supporting clinical information to insurance payors, as needed.

• Contact and verify eligibility and benefits with insurance company in a timely manner and obtain authorization to pre-certify service, document pre-certification notes in registration.

• Research and document insurance denials and resubmit authorizations as needed.

• Research, document and communicate patient financial responsibility amounts and initiate the point of service (POS) collections process; determine patient liability based on service levels and make necessary recommendations.

Communication and Documentation

• Communicate with external and internal case managers, social worker and managements teams on the status of cases.

• Communicate with department billing and claims team on the status of authorizations and denials.

• Responsible for information distributed via email and fax; check work email a minimum of 3 times daily and respond to inquiries within 24 hours (or within next business day)

• Using departmental standards, document all relevant conversations in EMR.

• Disseminate and/or complete pre appointment paperwork or online forms (consents, screening tools) with family during scheduling call.

Customer Service

• Work with managers and therapist to address any customer service concerns.

Organizational Accountabilities
Organizational Accountabilities (Staff)
Employee Excellence

• Demonstrates understanding of quality of service and collaborates with co-workers to ensure excellence standard is achieved.

• Innovates through improvement of care and/or efficiency of operational processes.

• Dedicated to a standard of performance excellence and high quality.

All In

• Embraces changes/improvements and actively participates in the implementation of new/improved programs, technology, new equipment, systems and resources that promote quality of care, safety and efficiency

• Identifies, prioritizes and selects alternative solutions to determine best outcome

Action Oriented

• Maintains a high level of activity/productivity, meeting deadlines and appropriately prioritizing tasks to meet business demands

• Anticipates problems and attempts to solve before they develop

Supervisory Responsibilities

• None

Blood Borne Pathogen Exposure

• Category III: Job does not involve exposure to blood, body fluids, non-intact skin or tissue specimens. Incumbent does not perform or help in emergency medical care or first aid as a part of his/her job.

Protected Health Information Access Level

• Level IV - Full Access Incumbents in this job may access any protected health information associated to a customer's needs, the service(s) rendered and the position's functions.

Working Environment

• This job operates in a hospital or office environment.

Physical Requirements
Travel Requirements

• This is a full-time, regular position working standard and extended hours.