Description:

Job Summary:

The Clinic Receptionist/Precertification Specialist serves as the first point of contact for patients and supports front-office operations in a Rural Health Clinic (RHC) primary care setting. This role is responsible for patient registration, scheduling, insurance verification, and obtaining prior authorizations (precertification's) for services. The position ensures accurate patient information, efficient workflow, and positive patient experience while supporting clinical and administrative teams.

Essential Duties and Responsibilities:

Supports the delivery of patient-centered service in a primary care clinic setting. Greets and registers patients, verifies demographic and insurance information, and ensures accuracy in the electronic medical record (EMR). Answer and directs incoming phone calls, schedules appointments, and manages appointment calendars efficiently. Performs insurance verification and eligibility checks prior to patient visits. Obtains and manages prior authorizations (precertification's) for procedures, diagnostic tests, medications, and referrals as required by payers. Communicates with insurance companies, providers, and patients regarding authorization requirements, status updates, and denials. Maintains tracking systems for authorizations, referrals, and outstanding documentation to ensure timely completion. Collects copayments, deductibles, and outstanding balances in accordance with clinic policies. Assists with patient check-in and check-out processes, including scheduling follow-up appointments and referrals. Ensures required forms, consents, and documentation are completed and filed appropriately. Coordinates with clinical staff to ensure all necessary documentation is available for insurance authorization requests. Maintains accurate and timely documentation of all interactions and processes within the EMR. Protects patient confidentiality and complies with HIPAA regulations in all interactions. Supports patient flow by communicating delays and maintaining organized front-desk operations. Assists patients with general inquiries regarding appointments, billing, and insurance processes. Maintains a clean, organized, and professional front office environment. Supports scanning, faxing, and other administrative tasks as needed. Assists with reporting and audits related to insurance verification and authorizations. Performs other duties as assigned to support clinic operations.

Professional Requirements:

Upholds and promotes the organization's Mission, Vision, Values, and Service Excellence standards. Demonstrates professional, respectful, and ethical behavior in all interactions. Maintains strict confidentiality in compliance with HIPAA and organizational policies. Adheres to all federal, state of Illinois, and organizational policies, procedures, and regulatory standards. Demonstrates strong teamwork, communication, and customer service skills. Maintains a safe and organized work environment in accordance with infection control and safety standards. Demonstrates reliability, punctuality, and accountability in assigned duties. Maintains certification and participates in ongoing training and competency validation. Demonstrates cultural sensitivity and provides respectful care to diverse patient populations. Exhibits flexibility and adaptability in response to changing clinic needs and priorities. Serve as a positive role model and contribute to a collaborative, team-oriented work environment. Completes and maintains all required education and/or training requirements. Complies with HIPAA regulations and always maintains patient confidentiality. Follows and maintains all lawful safety, health requirements and regulations, and follow protocols for required protective equipment (PPE). Promptly reports safety issues, job-related injury or illness, near misses, etc. in SafetyZone. Follows Hillsboro Health Standards of Behavior.

Requirements:

Education and/or

Experience:

High school diploma or equivalent required. Prior experience in a medical office, front desk, or healthcare administrative role preferred. Experience with insurance verification, prior authorizations, or medical billing strongly preferred. Familiarity with electronic medical record (EMR) systems preferred.

Certificates and Licenses:

Basic Life Support (BLS) required or willing to obtain within 30 days of hire.

Physical Demands:

Physical demands of the position, including vision, hearing, repetitive motion and environment are required. A separate document will be provided upon hire, during annual evaluation process, and upon request. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care.

CORPORATE COMPLIANCE

Receives training and/or attends necessary meetings to meet the criteria as outlined in Hillsboro Health's Corporate Compliance Plan and Code of Conduct. Understands the responsibilities related to compliance and knows whether to contact the Corporate Compliance Officer should there be any instance of question or concern regarding fraud and/or abuse.