At SCP Health, what you do matters As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care. Why you will love working here: Strong track record of providing excellent work/life balance. Comprehensive benefits package and competitive compensation. Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect. RESPONSIBILITIES: Work efficiently and in a professional manner utilizing multiple forms of engagement (blended inbound/outbound calls, chat, SMS/Text, and email) in a fast paced and challenging contact center environment across multiple lines of business. Manage general inquiries, track appointments, remind patients of appointments, and follow all processes and procedures while demonstrating sensitivity to any issues. Serves as a navigator to the clinic/hospital for insurance companies or insurance utilization review department by providing clinical information to obtain pre-certification from payers/adjusters/nurse case managers for workers’ compensation referrals. Intake accurate collection of data to complete the coordination of care/referral for program service lines (occupational health services and workers compensation visits). Assist and track referrals/appointment scheduling, prior authorizations, and/or insurance billing verification, when applicable for tests/procedures, including surgical procedures, diagnostic procedures, provider appointments, outpatient rehab services, etc. Assemble information concerning referral needs to assist with expediting and coordinating care. Per client referral guidelines, provide information to appropriate parties to assist with referral navigations/care coordination within client’s health system/hospital. Responsible for staying abreast of state specific worker’s compensation and occupations health laws and regulation. Check eligibility and obtain authorization for ordered services via insurance companies or acceding vendor portals. Track and reconcile patient referral orders for assigned areas with follow through to completion, such as return to work regular duty or maximum medical improvements (MMI). Contact utilization review organizations and insurance companies (adjusters and nurse case managers) to ensure prior approval requirements are met. Present necessary medical information such as clinical notes, orders, and/or referrals for said services. May assume advocate role on the patient's behalf with the carrier to ensure approval of the necessary services for the patient in a timely fashion. Utilize client department service lines and identified service providers to coordinate care. Establish and maintain relationships with identified service providers, work comp adjusters and nurse case managers. Ensure that referrals are addressed in a timely manner and track all referral outcomes. Communicate and remind patients, employers, adjusters, and nurse case managers of scheduled appointments. Meet key performance goals including call handling metrics, quality performance, and attendance. All other duties as assigned. QUALIFICATIONS: Education High School Diploma or equivalent required Medical Office Administration experience or Medical Assistant Certification preferred Certification and Licenses Medical Assistant Certification preferred Previous Experience Two years’ patient care coordination or patient scheduling experience or equivalent One year customer service experience Previous occupational health, or workers compensation experience preferred EMR experience a plus Knowledge Skills and Abilities: Thrives working in fast based, changing, and growth-oriented environment Ability to quickly learn new processes and workflows Ability to listen to caller while entering data and documenting information accurately Strong communication skills, oral and written Great active listening skills Patient and empathetic attitude Excellent interpersonal skills Computer literate with attention to detail and the ability to learn new software applications and methods of engagement Problem solving abilities Excellent customer service skills Bilingual a plus but not required Pay Range: 13.00 - 19.00 USD per hourThis range represents the anticipated base salary for this role. Actual compensation will be determined based on experience, qualifications, and internal equity considerations. - We offer a comprehensive benefits package designed to support your health, financial well-being, and work-life balance, including medical dental, vision insurance, a 401(k) plan with a company match, paid time off and holidays, professional development support, and employee wellness resources. Visit our website for further information. https://myscpbenefits.com/ Login name: corp-guest Password: weheal