CLINICAL ORDER SPECIALIST - NOMC ADMISSIONS

Status: Full Time

Shift: Hours vary.

Exempt: No 

Summary:

Under the supervision of the Patient Access Supervisor and Patient Access Manager, the Clinical Order Specialist (COS) oversees and is responsible for management of all provider diagnostic testing, therapeutic and rehabilitative service orders sent to North Oaks Medical Center through electronic fax. This only pertains to future orders faxed to the Patient Access Department for North Oaks Medical Center patients. This excludes orders faxed directly to other departments within North Oaks Medical Center. The Clinical Order Analyst ensures patient safety using clinical expertise to review the procedure/services ordered and the associated diagnoses and transcribes them timely and accurately in the patient’s electronic medical record. Orders that do not meet valid order criteria established by North Oaks Medical Center will not be transcribed. The COS will take necessary steps to facilitate the receipt of valid orders. The COS will provide excellent customer service throughout the order management process within Patient Access. 

Other information:

1. Education Required: High School Diploma; Certified Radiology Technologist with at least two years of clinical experience in a hospital setting.

2. Knowledge, Skills, and Abilities: Medical Terminology desired; ability to communicate over the telephone; excellent customer service skills. Must be able to interpret complex documents related to insurance benefits. Must be able to read and understand physician’s orders.

3. Intermediate computer skills required; ability to operate a computer using Word, Excel, and email, fax machines, printers, and copiers.

4. Physical Skill Required: Must have considerable hand-eye coordination to operate a computer. Must be able to sit or stand for long periods of time. Must be able to bend or squat to patient’s level. Must be able to lift and carry supplies to department and to equipment (example: reams of paper to copiers/fax machines).Strength: Light Push: Occasionally Pull: Occasionally Carry: Occasionally Lift: Occasionally Sit: Constantly Stand: Occasionally Walk: Constantly

Responsibilities:

Responsibilities

Patient Access:

Order Management

A. Reviews authenticated order/orders from the provider and enters them electronically in the electronic health record.

B. Understands the relevance of and ensures that an order meets the North Oaks Medical Center order compliance policy.

C. Uses clinical expertise to determine if the procedure ordered is appropriate for the diagnosis and meets medical necessity and care standards established by each ancillary department as well as radiologists. Confers with other clinicians as needed.

D. Communicates professionally and effectively with providers to clarify necessary actions to facilitate a valid order. Seizes all opportunities to provide ordering provider education.

E. Acts as a liaison for external providers and North Oaks Medical Center as it relates to orders for procedures, tests, therapeutic and rehabilitative services.

F. Demonstrates basic knowledge of payer types including, but not limited to, Commercial, Medicare, Medicaid, VA, Other Governmental, Worker’s compensation, Managed care, and Self-pay and how each influences the order process.

G. Demonstrates working knowledge of the Medicare Advanced Beneficiary Notice (ABN) process to communicate effectively with providers, patients and other internal clinicians.

H. Demonstrates working knowledge of Medicare Local and National Coverage Determinations.

I. Demonstrates working knowledge of CPT and ICD codes.

J. Ensures patient safety by accurately transcribing orders.

K. Supports the Patient Access department’s role in the revenue cycle by transcribing the correct procedure facilitating accurate scheduling, authorization, and estimate workflows.

L. Ensures legal compliance, patient safety, and system financial integrity by performing state license verification, sanction and exclusion verification as well as NPI verification on all providers not already listed in the hospital information system.

M. Transcribes all patient orders received from providers as directed. Understands the urgency in quickly and accurately indexing patient orders.

N. Reviews other (non-order) documents that may be sent via fax. Makes sure each document is indexed to the correct document type, including, but not limited to, Advance Directives (living will and durable power of attorney for health care) in accordance with Federal, State, and TJC requirements, Any other payer or facility required forms or documents, letters of authorization for services from the payers. Seeks clarification of proper document type for other documentation received.

O. Transcribes orders and attaches the orders to the correct hospital account registration (HAR) or creates an “orders only encounter” for an unscheduled test or procedures.

P. Acts as a clinical resource for all orders to all Patient Access Staff. Provides education as needed to perform basic order transcription.

Q. Provides oversight to the Patient Access Order Specialist Assistant.

Patient Access: Document Coordination

A. Verifies orders are accurate.

i. Patient Demographics, two patient identifiers

ii. Physician Signature

iii. Clarity of procedure ordered

iv. Diagnosis

v. Medical Necessity (procedure related to the diagnosis)

B. Transcribes and Indexes Orders.

i. Transcribe orders within Epic

ii. Index orders from Hyland

iii. Verify order links to appointment scheduled

C. Performs other duties as directed by supervisor.

Patient Access: Fiscal Responsibility

A. Expedites claim submission by working Patient Access work queues as assigned.

CUSTOMER SERVICE

A. Provides assistance, guidance, and directions to visitors, patients, employees, vendors and physicians.

B. Secures escort or directs patient to the appropriate service area.

C. Ensures that patients are in the appropriate area for registration, directing patients needing to go to other areas with instructions.

D. Maintains competency in Service Recovery utilizing AAA (refer to polies and procedures).

1. A – Acknowledge2. A – Apologize3. A – Amend

E. Maintains personal appearance following the department and facility’s dress code.

F. Maintains the appearance of the waiting/lobby area. Calls housekeeping when necessary.

G. Utilizes the 4 Cs in all interactions (refer to policy)

COMMUNICATIONS

A. Establishes effective relationships with co-workers in own department as well as other departments.

B. Assists other and shows willingness to work as a team player.

C. Performs appropriately in difficult situations by remaining calm, notifying appropriate personnel and initiating appropriate action.

D. Responds to inquiries from patients, relatives, physicians, insurance companies and the general public quickly and efficiently by actively listening and taking appropriate action.

E. Discusses problems and/or confidential information only in appropriate setting and only with appropriate personnel. Keeps any confidential documents secure and out of the public view.

F. Maintains par level of supplies and communicates to immediate supervisor when supplies are needed.

G. Ensures all equipment is functional and ready for service, including paper levels in copiers, printers, and fax machines.

H. When identified, removes and labels broken equipment or furniture from patient and visitor areas. Immediately notifies the appropriate department to remove item and/or fix broken item.

I. Calls for all other service repairs as need is identified.

OTHER DUTIES

A. Attends ins-services, mandatory education and monthly department meetings

B. Performs other duties as assigned by supervision.

C. Performs duties in a safe manner and follows North Oaks Health System’s safety polices and procedures.

D. Follows North Oaks Health System’s Compliance Programs and Federal and State Regulatory guidelines.