Pre-Authorization Scheduling Coord

About the role

This position involves receiving physician and patient communications to schedule patients and managing the registration process. Duties include interviewing patients and obtaining registration data accurately and promptly.

Responsibilities

• Schedules outpatient procedures via telephone with patients and offices.
• Cover multiple procedures for patients to ensure they are scheduled on the same day and within an appropriate timeframe.
• Provide patients and offices with accurate instructions regarding the scheduled procedure (e.g., NPO, arrival time).
• Check order documents for completeness and validate orders against scheduled services.
• Clearly document activities and actions taken on accounts, including authorization, communication with patients, staff, and other departments.
• Maintain scheduling and registration accuracy at a 95% threshold as identified in audit processing.
• Perform prior authorization process by conducting medical reviews and entering authorizations into the system.
• Work with the billing department to research and resolve rejected, incorrectly paid, and denied claims as requested.
• Multi-task and perform duties well under pressure, meeting deadlines.
• Obtain demographic, billing, and insurance information from patients/families/legal guardians and enter it into the scheduling and registration/billing systems for service and claim processing.
• Use applicable CPT and ICD-9 codes, verify insurance, validate pre-cert/pre-auth information, and record results in the system.
• Complete Medicare Secondary Payer forms, where applicable, and perform medical necessity screenings.
• Cancel or reschedule patients according to hospital workflows.
• Exercise proper stewardship through the appropriate use of supplies, equipment, and time.
• Follow hospital, state, and federal guidelines for ensuring a safe environment for workers, patients, and the public.
• Ensure compliance by staff to hospital, governmental, and insurance regulations.
• Participate in in-services, staff meetings, continuing education courses, hospital-wide committees, and other meetings as needed or required.
• Achieve compliance with regulatory requirements and report results of assessment and improvement processes to the appropriate administrative level.
• Perform other duties as assigned which support the mission and values of the organization.

Requirements

Minimum qualifications include a high school diploma or equivalent, one year of recent experience in a physician/hospital scheduling and registration or business office environment, a completed Medical Assistant (MA) degree, or an Associate Degree.

Qualifications

Strong communication skills, working knowledge of office equipment and computers, excellent customer service and telephone etiquette, ability to use tact and diplomacy in dealing with others, use of a computer keyboard, monitor, and mouse, answering telephones and transcribing messages, communicating 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, experience and knowledge in admissions, registration, and insurance verification.

Skills and Abilities

• Strong communication skills.
• Working knowledge of office equipment and computers.
• Excellent customer service and telephone etiquette.
• 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.
• Experience and knowledge in admissions, registration, and insurance verification.

Benefits

N/A

Pay

N/A

Schedule

N/A

Additional Job Description

Scheduled Weekly Hours: 40
Shift: Exempt/Non-Exempt
United States of America (Non-Exempt)
Company: PVH Potomac Valley Hospital
Cost Center: 550
PVH Scheduling Call Center
Address: 100 Pin Oak Lane
Keyser West Virginia
Equal Opportunity Employer
West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws.