REMOTE Scheduling Specialist I

Essential Functions

• Responsible for pre-registration, scheduling, electronically verifying insurance eligibility & accurately identifying & collecting patient financial responsibility.
• Handles complex scheduled events, including high dollar testing, associated studies & those with study specific instructions & communicates effectively to service delivery areas to maximize patient flow & customer service.
• Begins the overall patient experience & initiate the billing process for any services provided by the hospital.
• Analyzes patient insurance(s), identifies the correct insurance plan, selects appropriately from HIS insurance and plan selections and documents correct insurance order.
• Applies recurring visit processing according to protocol.
• Verifies patient information with third party payers.
• Collects insurance referrals and documents within HIS.
• Communicates with patients and physician/offices regarding authorization/referral requirements.
• Identifies potential need for financial responsibility forms or completed electronic forms with patients as necessary.
• Escalates accounts appropriately in accordance with department Defer/Delay policy to manager.
• Screens outpatient visits for medical necessity and issues Advanced Beneficiary Notice as appropriate for Medicare primary outpatients.
• Provides cost estimates.
• Collects and documents Medicare Secondary Payer Questionnaire (MSPQ) and obtains information from the patient if third party payers need to be billed (i.e., worker's compensation, motor vehicle accidents and any other applicable payer).
• Maintains operational knowledge of regulatory requirements and guidelines as outlined in the hospital and department Compliance Plans.
• Ensures Meaningful Use requirements are met as appropriate.
• Screens all patients self-pay & out of network patients using approved technology.
• Provides information for follow up and referral to the RHM Medicaid Vendor and/or Financial Counselor as appropriate.
• Initiates payment plans and obtains payment.
• Incorporates point of service (POS) collection processes into daily functions.

Minimum Qualifications

• A High School Diploma or equivalent.
• Two (2) to Five (5) years experience in area of expertise such as scheduling, financial clearance, or patient access.
• National certification in HFMA CRCR or NAHAM CHAA required within one (1) year of hire.
• Must be proficient in the use of Patient Registration/Patient Accounting systems & related software systems.

Additional Qualifications (nice To Have)

• Associates Degree, preferred.
• Comprehensive knowledge of scheduling with mastery in at least three (3) or more modalities & insurance verification processes with three (3) years scheduling experience in an acute care setting.
• Experience in complex facility based ancillary testing across multiple facilities/states.
• Strong knowledge of third-party & government payer billing & reimbursement guidelines as well as department performance standards & policies & procedures.