Pre-Authorization Scheduling Coord.

About the role

Receives physician and patient communications to schedule patients and manages the registration process. Responsible for accurate and timely interviewing of patients and/or relatives in a courteous manner to obtain registration data based upon comprehensive data elements to complete the registration process.

Responsibilities

• Schedules outpatient procedures via telephone with patients and offices in a courteous, professional manner.
• Coordinates multiple procedures patients have to ensure they are scheduled on the same day and within an appropriate time frame.
• Provide patients and offices with accurate instructions regarding the scheduled procedure (i.e., NPO, arrival time, where to arrive, etc.).
• Check order documents for completeness. Validate orders against scheduled services.
• Clearly documents activities and actions taken on accounts, which include but are not limited to, authorization, communication with patients, staff, and other departments.
• Maintains scheduling and registration accuracy threshold of 95% as identified in audit processing.
• Perform prior authorization process by performing medical review and entering authorizations into system.
• Works and assists with the billing department in researching and resolving rejected, incorrectly paid, and denied claims as requested.
• Ability to multi-task and perform duties well under pressure while meeting deadlines.
• Obtains demographic/billing/insurance information from patient/family/legal guardian and correctly enters into the scheduling and registration/billing systems for service and claim processing.
• Understand and use applicable CPT and ICD-9 codes.
• Verify insurance; validate pre-cert/pre-auth information after completion of insurance verification and record results in system.
• Performs other insurance-related functions as required or necessary.
• Completes Medicare Secondary Payer forms, where applicable.
• Completes medical necessity screening. Verify medical necessity for applicable payer and service.
• Cancel or reschedule patients in accordance with hospital workflows.
• Exercises proper stewardship through the appropriate use of supplies, equipment, and time.
• Follows hospital, state, and federal guidelines for ensuring a safe environment for workers, patients, and the public.
• Ensures compliance by staff to hospital, governmental, and insurance regulations.
• Actively participates in in-services, staff meetings, continuing education courses, hospital-wide committees, and other meetings as needed or required.
• Participates in the processes to assess and improve the services provided and compliance with regulatory requirements.
• Reports results of assessment and improvement processes to the appropriate administrative level.
• Performs other duties as assigned which support the mission and values of the organization.
• Willingly accepts assignments within scope of practice, skill set, and level of competence.

Requirements

• High school diploma or equivalent required.
• One year of recent experience in a physician/hospital scheduling and registration or business office environment OR completed Medical Assistant (MA) degree OR Associate Degree.

Physical Requirements

• Must meet Department of Labor’s MEDIUM duty standard (MEDIUM WORK- exerting up to 50 pounds of force occasionally, and/or up to 20 pounds of force frequently, and/or up to 10 pounds of force constantly).
• Able to bend, stoop, reach, and be capable of normal rotation, standing, and walking for an 8-10 hour shift.

Working Environment

• May be required to travel between facilities/buildings.

Skills

• Strong communication skills.
• Working knowledge of office equipment and computers.
• Excellent customer service and telephone etiquette.
• Must demonstrate the ability to use tact and diplomacy in dealing with others.
• Use a computer keyboard, monitor, and mouse.
• Answer telephones and transcribe messages.
• Communicate verbally, written, and electronically with healthcare personnel, families, and patients.
• Working knowledge of healthcare insurance plans.
• Working knowledge of hospital clinical departments and service protocols.
• General knowledge of hospital payment plan guidelines.
• General knowledge of healthcare coding practices.
• Experience and knowledge in admissions, registration, and insurance verification.

Schedule

Scheduled Weekly Hours: 40