Overview

Description Summary: The Ambulatory Service Representative (ASR) Senior serves as a senior expert in orchestrating comprehensive administrative and logistical support for patients within a dynamic ambulatory setting. This role demands a high degree of independent judgment, advanced problem-solving skills, and the ability to navigate complex healthcare scenarios. The Senior Representative will manage intricate scheduling for routine and urgent appointments, advanced medical procedures, and diagnostic tests, ensuring seamless coordination of all associated ancillary services. Beyond direct patient interaction, this role involves proactive identification and resolution of systemic issues, mentoring junior staff, and collaborating with clinical leadership to optimize patient flow and experience. Responsibilities: Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders. Receives and directs phone calls from patients and physician offices, effectively triaging inquiries and providing accurate information or routing calls to appropriate personnel. Schedules patients for treatment by multiple providers and treatment areas and arranges a variety of associated tests and procedures according to established guidelines and specific criteria, demonstrating an understanding of complex scheduling requirements. Prioritize appointments in a manner that fosters optimum patient care, efficient utilization of physicians' clinical staff, as well as equipment and facilities, applying established protocols for prioritization. Handles urgent patient care calls, accurately assessing the urgency of symptoms and concerns, and alerting providers to emergent patient care needs following defined escalation procedures. Schedules urgent care appointments as needed and directed by a physician, demonstrating the ability to react quickly and efficiently to immediate patient needs. Greet patients for scheduled and/or urgent care appointments and procedures, providing a welcoming and informative initial point of contact. Confirms and verifies patient demographic and insurance information, identifying and resolving basic discrepancies. Collects co-payments from patients upon arrival when applicable, accurately processes payments, and provides receipts. Obtains signatures of consent from patient/guardian for treatment authorization and insurance/billing information, ensuring all necessary documentation is complete. Collaborates with insurers to obtain patients' prior authorizations for routine procedures and tests as needed, following established communication channels and documentation requirements. Follow guidelines established by insurers to ensure that pre-authorization, pre-certification, and physician referrals for treatment are obtained before patient visits, identifying when these are needed. Reviews and audits basic billing discrepancy reports and researches straightforward errors for resolution, escalating more complex issues to a senior team member. Verifies eligibility for standard procedures or tests from various health care institutions, utilizing established verification processes. Maintains accurate and timely records, logs, charges, files, and other related information as required, ensuring data integrity and accessibility. Manages end-to-end referral workflows for internal and external providers, including reviewing referrals for completeness, obtaining required documentation and approvals, coordinating with referring offices and specialty clinics, and tracking referrals through appointment completion. Obtains prior authorizations, pre-certifications, and referral approvals for specialized services, procedures, diagnostics, and consults. Coordinates with payers to interpret benefit coverage, authorization requirements, and referral limitations, escalating payer conflicts or denials as appropriate. Identifies referral-related trends, barriers, and systemic issues, collaborating with leade