Scheduler-Full Time-Days

Summary

Obtains and/or verifies demographic, clinical, financial, and insurance information in the process of appointment making for patient tests and procedures, pre-registering and financial clearing for service delivery. Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance. Additionally, the incumbent obtains and processes signed physician orders to ensure clinical documentation for care delivery. The incumbent conducts online insurance eligibility/benefit verification, pre-certification/authorization, referral clearance and financial education on designated cases. As appropriate, the incumbent notifies patient/guarantor and collects patient liabilities, and refers appropriate cases to resource counseling for follow-up and consultation.

Major Job Functions

• Receive orders and schedule outpatient appointments for all modalities except biopsy and special procedures and all radiology outpatient facilities
• Determines proper scheduling requirements and/or limitations according to requested tests/procedures and schedules resources (equipment, staff, room, etc.)
• Captures insurance eligibility/benefit verification, utilizing a variety of mechanisms (EDI transactions, web access and by calling payers) and documenting information within the appropriate registration system; supporting with reference number
• Pre-registers the patient for upcoming visit(s)
• Calls patient to remind of appointment date, time, location, and preparation for procedures following protocols; as well as informs the patient of their financial responsibility, answer questions and give directions
• Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance. Informs patient/guarantor of their liabilities and collects appropriate patient co-payments, co-insurances, deductibles, deposits and outstanding balances at the point of pre-registration
• Provides patient, family and physician office education during scheduling process to inform them of preparations needed for diagnostic testing and proper scheduling instructions
• Sends and/or communicates appointment confirmation to referring office
• Reconciles charge reports daily and communicates errors to staff

Minimum Qualifications

• High school diploma or equivalent required
• College courses in Business or Health Care Administration and/or Computer Technology preferred
• Medical terminology required within one year of employment
• 1 year insurance/clerical experience within a hospital or medical office setting preferred
• Proficiency in reading, writing, and speaking the English language
• Must pass pre-employment testing and post-training testing
• Must have knowledge of insurance and collection of payments
• Must have experience with Microsoft software
• Must possess excellent verbal and written communication skills, customer service skills and problem-solving abilities
• Must be multi-skilled with the ability to appropriately handle complexity and stress with the changing needs of the patients, families, visitors, and the Health System
• May be required to periodically rotate shifts and regular days off
• All system employees must have the flexibility to meet the department hours of operation

Physical Requirements

• Must be able to communicate orally, see, and hear to collect information
• Must have dexterity to operate office equipment
• Work area is well-lit, temperature controlled and free from hazards
• The noise level is low to moderate
• Answers telephone calls, uses personal computer and other business machines extensively
• Bends, reaches, pushes and pulls file drawers to file records and reports
• Regularly lift or move up to 10 pounds, frequently lift or move up to 25 pounds and occasionally lift or move up to 50 pounds