What are the responsibilities and job description for the Prior Authorization & Central Scheduler position at HAWARDEN REGIONAL HEALTHCARE?
Job Details
Description
Under limited supervision, responsible for scheduling ancillary departments appointments and procedures for patients as directed by the providers. Responsible for determining eligibility for all applicable payors by facilitating and overseeing prior authorizations and Local Coverage Determinations.
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ESSENTIAL JOB FUNCTIONAL COMPETENCIES: |
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Demonstrates the knowledge and skills necessary to provide service/care appropriate to the age of the patients served, in accordance with Hawarden Regional Healthcare standards. Maintains a working knowledge of applicable Federal, State and local laws and regulations, the Compliance Accountability Program, Code of Ethics, and HRH policies and procedures, including all provisions of the Health Insurance Portability Act of 1996 (HIPAA). In order to ensure adherence in a manner that reflects honest, ethical and professional behavior by implementing the organizational vision, values, and mission. |
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Maintain the Centralized Scheduling module. |
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Completes Inpatient, Observation bed prior authorizations & provides swing bed prior authorization coverage as needed. |
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Obtains information obtains information regarding provider orders from provider offices for scheduling tests, procedures, referrals and admissions in an accurate, timely and sequential manner; including Radiology, Outpatient Nursing, Outpatient Clinics, & PFTs. |
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Demonstrates good rapport and cooperative working relationships with provider office staff, all hospital departments, providers and co-workers. |
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Assists with collection, sharing and maintenance of records and orders. |
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Demonstrates technological knowledge and skills sufficient to integrate the use of health care technology and/or information management systems as it pertains to scheduling. |
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Demonstrates eligibility for all applicable payors by obtaining a prior authorization or Local Coverage Determination (LCD) if needed. |
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Facilitates in coordinating a plan of care for patients by communicating plans of treatment with all applicable entities. |
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Educates patients of all financial, insurance, and visit expectations prior to procedures or tests. |
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General clerical duties to include, but not limited to ordering supplies, making copies, faxing documents, greeting, answering/monitoring phones, making appointments, relaying messages. |
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Knows, understands, incorporates, and demonstrates the Hawarden Reginal Healthcare Standards of Excellence |
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Maintains confidentiality of information pertaining to patients, practitioners & employees. |
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Demonstrates general working knowledge of computers and department specific software (i.e. Healthstream, internet, etc.) |
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Actively participates in departmental meetings, committees, conferences, and in services. Is knowledgeable of and complies with Safety and Infection Control Policies & Procedures. Participates in Continuous Quality Improvement activities as requested. Keeps up to date on new procedures and research. Maintains confidentiality of information pertaining to clients, providers, employees and HRH business. |
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Completes all mandatory training such as Healthstream, The Patient Experience, Safe Choices, and any other training as designated by Administration. |
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Performs other duties and responsibilities as assigned. |
The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification. They are not to be construed as an exhaustive list of duties so assigned.
MISSION STATEMENT
Provide for the health and wellness of all in our communities through delivery of quality healthcare services close to home.
STANDARDS OF EXCELLENCE
The standards of excellence are the behaviors necessary for all of us to achieve our Vision. They are:
- Trust – Being a reliable resource for patients, families and co-workers by acting with honesty and integrity at all times.
- Caring – Displaying kindness and concern for others by creating a welcoming environment for all those who enter our facility.
- Communication – Giving and receiving information that others need or desire.
- Pride – Fulfillment of being a part of something bigger than yourself.
- Accountability – Taking responsibility for my actions and decisions.
- Respect – Honoring our patients, families and co-workers.
COMMITMENT
Must be able to embrace and adhere to the standards of excellence of the organization and support the Mission of Hawarden Regional Healthcare.
Must demonstrate good work habits such as time management, attendance, punctuality, team building and other behaviors aligned to the mission and values of the organization.
Qualifications
- High School diploma or equivalent required.
- Previous experience of one to two years in a medical office or health care facility preferred.
- Is able to communicate effectively with customers and all members of the health care team.
- Is able to perform a variety of duties characterized by frequent change.
- Must have general working knowledge of computers and clinic specific software
Hawarden Regional Healthcare cultivates, upholds and supports a safe work environment. Employees support patient and staff safety by demonstrating aptitude and maintaining organizational employment standards and requirements. Employee job performance is continually appraised and formally evaluated during the course of employment with Hawarden Regional Healthcare.
PHYSICAL REQUIREMENTS:
- Must successfully pass pre-employment physical examination, drug screening, and must adhere to applicable organizational requirements on an annual basis for Employee Health Directives.
- Has the physical stamina to meet the requirements of this job description. Primarily works inside with frequent sitting, walking, standing, bending and occasional lifting over 25 pounds. Knowledge of body mechanics necessary.
- Able to perform effectively under stressful situations
- Must understand and accept the possibility of exposure to environmental elements, internal and external, which may affect the work place, such as inclement weather, dust, noise, chemicals and/or chemical fumes, and infectious disease.
- Regular and physical attendance at work is an essential function of the job.
These essential functions identify the major requirements of the job. They are not an exhaustive list of all job requirements. An employee may be called upon to perform physical actions not specifically identified in this job description.
