Summary
The Clinic Support Specialist (CSS) supports clinic operations for the assigned prosthetics and/or orthotics medical practices within BCP Group/Össur Clinics. The Clinic Support Specialist is responsible for evaluating chart documentation for delivery approval, setting priorities for clinic staff, obtaining insurance prior authorizations, training new PCCs in their Region, supporting the integration of new locations through process and staff evaluation and education, and supporting Clinic and Regional Management from an operations perspective.
Essential Functions
Performs Green Light/Compliance reviews of documentation from physicians and other healthcare providers and ensures information is included as part of the patient's medical record prior to product delivery and claim submission.
Determines whether and when items may be delivered based on a matrix of factors including but not limited to chart content, payer, timing, and financial and compliance risk.
Acts as WIP Manager in assigned Clinics, setting priorities for deliveries, follow-ups on outstanding documentation, and running weekly WIP Meetings.
Drafts Physician’s Note Guides for prosthetic patients prior to patient office visits. Works with Practitioners to determine medically necessary documentation criteria.
Defines training plans for and leads training of Patient Care Coordinators in workflow protocols and WIP Management for their assigned clinics.
Supports new market/clinic integrations, including traveling to the clinic site to conduct pre and post-close workflow and staffing assessments, and trainings in Compliance, Workflow, and WIP Management.
Identify training needs through ongoing performance evaluation, work alongside Director of Clinic Support to develop & implement training plans accordingly
Serves on crisis-intervention team for struggling clinic locations facing staffing, compliance, workflow, and/or management challenges
Provides support to Clinic offices, as needed. Strives for a paperless work environment and full-utilization of technology‐based processes to drive operational efficiencies. Designs and implements process improvements to this goal.
Submits Prior Authorization packages to insurance Payers, as required. Verifies authorization approvals and relays information on relevant payment and billing/collection policies back to the Clinics.
Other duties as assigned.
Competencies
Ethical Conduct
Problem Solving/Analysis
Communication Proficiency
Computer Proficiency
Demonstrates excellent interpersonal skills with the ability to interface with patients, physicians, and coworkers in a tactful, informed and service‐oriented manner.
Detailed oriented.
Work Environment
This job is Remote with occasional travel required, up to 30% required. Will work on-site in Clinic environments occasionally. This role routinely uses standard office equipment such as computers, phones, photocopiers, scanners, and fax machines.
Physical Demands
The employee is regularly required to talk or hear. The employee frequently is required to stand; walk; use hands to finger, handle or feel; and reach/pull with hands and arms, bend and squat.
Qualifications
Bachelor’s degree in business, healthcare, or related field or equivalent combination of education and experience required.
2+ years of experience in the O&P industry utilizing EMR systems.
Prior experience and working knowledge of Commercial, Medicare, & Medicaid Insurances including authorizations, appeals/denials.
Working knowledge of Medicare LCD’s and Policy Articles for O&P
Prior experience as a Patient Care Coordinator within the company’s clinical offices desired, but not required.
Compliance Certified
Proficient with Microsoft Office, Opie/Nymbl EMRs, ICD10 coding, medical terminology
Embla Medical is an equal opportunity employer and makes employment decisions on the basis of merit. We want to have the best available individual in every job.
Embla Medical's equal opportunity policy prohibits all discrimination (based on race, color, creed, sex, religion, marital status, age, national origin or ancestry, physical disability, mental disability, military service, pregnancy, child birth or related medical condition, actual or perceived sexual orientation, or any other consideration made unlawful by local laws around the world).
Embla Medical is committed to complying with all applicable laws providing equal employment opportunities. This commitment applies to all individuals involved in the operations of Embla Medical and prohibits discrimination by any employee of Embla Medical, including supervisors and co-workers.
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