Physician Services Specialist, Ortho, Full Time, First Shift

Administration

• Answers telephone and directs to correct person if needed.
• Manages Outlook Calendar for providers within the clinic.
• Manages office incoming mail.
• Manages incoming communication related to case authorization.
• Validates registration information with patients and verifies all third-party payors (i.e. BWC, accident insurance, etc).
• Engages in population appropriate communication.
• Gives clear instructions to patients/family regarding treatment, diagnostic, procedural or surgical plan as directed by clinical team.
• Makes sure planned diagnostic procedures are followed up in a timely manner.
• Prepares for upcoming clinics related to procedural planning.
• Carefully manages clinic template changes to meet case and procedural obligations.
• Carefully manages provider calendar related to faculty obligations.
• Handles in-basket management tasks.
• Completes FMLA, Disability, BWC form coordination.
• Schedules and coordinates patient services, surgeries, tests, and other procedures as needed.
• Coordinates all pre-procedural testing, diagnostic studies, medications, and other services as needed.
• Communicates with patients via phone and in person regarding scheduling related matters.
• Manages OR block time with providers Outlook calendar if applicable based on department guidelines.
• Reviews and coordinates case changes identified with leadership related to urgency, case order, or unforeseen delays.
• Helps review daily schedules as needed and informs leadership if changes are needed or discrepancies are identified.
• Liaises between staff and procedural areas for scheduling needs.
• Coordinates with all product or device representatives for cases.
• Completes complex coordination with co-surgeons in other surgical practices for joint case authorization and scheduling.
• Completes case request and referral order entry.
• Data Management:
• Performs audits on patient records/registration for insurance billing and compliance.
• Reviews office notes to ensure all required items are noted for authorization request.
• Performs pre-authorizations and pre-certifications using care management protocols.
• Utilizes payer portals to complete case, procedure, and visit authorizations.
• Coordinates peer-to-peer reviews for pending case authorization.
• Obtains CPT codes for all surgical and procedural cases and submits for authorization.
• Obtains retro authorizations as needed.
• Coordinates with utilization review for authorization status to avoid financial risk.
• Updates documentation in referral tab with all authorization updates.

Scheduling

• Schedules and coordinates patient services, surgeries, tests, and other procedures as needed.
• Coordinates all pre-procedural testing, diagnostic studies, medications, and other services as needed.
• Communicates with patients via phone and in person regarding scheduling related matters.
• Manages OR block time with providers Outlook calendar if applicable based on department guidelines.
• Reviews and coordinates case changes identified with leadership related to urgency, case order, or unforeseen delays.
• Helps review daily schedules as needed and informs leadership if changes are needed or discrepancies are identified.
• Liaises between staff and procedural areas for scheduling needs.
• Coordinates with all product or device representatives for cases.
• Completes complex coordination with co-surgeons in other surgical practices for joint case authorization and scheduling.
• Completes case request and referral order entry.

Data Management

• Performs audits on patient records/registration for insurance billing and compliance.
• Reviews office notes to ensure all required items are noted for authorization request.
• Performs pre-authorizations and pre-certifications using care management protocols.
• Utilizes payer portals to complete case, procedure, and visit authorizations.
• Coordinates peer-to-peer reviews for pending case authorization.
• Obtains CPT codes for all surgical and procedural cases and submits for authorization.
• Obtains retro authorizations as needed.
• Coordinates with utilization review for authorization status to avoid financial risk.
• Updates documentation in referral tab with all authorization updates.