Pre-Authorization Scheduling Coordinator

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

MINIMUM QUALIFICATIONS :

EDUCATION, CERTIFICATION, EXPERIENCE, AND / OR LICENSURE :

• 1. High school diploma or equivalent required AND 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.

CORE DUTIES AND RESPONSIBILITIES :   The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an exhaustive list of all responsibilities and duties. Other duties may be assigned.

1. May be scheduled to work various shifts based on departmental and patient needs.

2. Schedules outpatient procedures via telephone with patients and offices in a courteous, professional manner.

3. Coordinates multiple procedures patients have to ensure they are scheduled on the same day and within an appropriate time frame.

4. Provide patients and offices with accurate instructions regarding the schedule procedure (i.e., NPO, arrival time, where to arrive, etc.).

5. Check order documents for completeness. Validate orders against scheduled services.

6. Clearly documents activities and actions take on accounts, which include but not limited to, authorization, communication with patients, staff and other departments.

7. Maintains scheduling and registration accuracy threshold of 95% as identified in audit processing.

8. Perform prior authorization process by performing medical review and entering authorizations into system.

9. Works and assists with the billing department in researching and resolving rejected, incorrectly paid, and denied claims as requested.

10. Ability to multi task and perform duties well; while under pressure; while meeting deadlines.

11. 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.

12. Understand and use applicable CPT and ICD-9 codes.

13. Verify insurance; validate pre-cert / pre-auth information after completion of insurance verification and record results in system. Preforms other insurance related functions as required or necessary.

14. Completes Medicare Secondary Payer forms, where applicable. Completes medical necessity screening. Verify medical necessity for applicable payer and service.

15. Cancel or reschedule patients in accordance with hospital workflows.

16. Exercises proper stewardship through the appropriate us of supplies, equipment, and time.

17. Follows hospital, state and federal guidelines for ensuring safe environment for workers, patients and public. Ensures compliance by staff to hospital, governmental and insurance regulations.

18. Actively participates in in-services, staff meetings, continuing education courses, hospital wide committees and other meetings as needed or required.

19. Participates in the processes to assess and improve the services provided and compliance with regulatory requirements. Reports results assessment and improvement processes to the appropriate administrative level.

20. 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.

PHYSICAL REQUIREMENTS :   The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. 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).

2. Able to bend, stoop, reach and be capable of normal rotation, standing and walking for an 8-10 hour shift.

WORKING ENVIRONMENT :   The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. May be required to travel between facilities / buildings.

SKILLS AND ABILITIES :

1. Strong communication skills. Working knowledge of office equipment and computers.

2. Excellent customer service and telephone etiquette. Must demonstrate the ability to use tact and diplomacy in dealing with other.

3. Use a computer keyboard, monitor and mouse. Answer telephones and transcribe messages. Communicate verbally, written and electronically with healthcare personnel, families and patients.

4. Working knowledge of healthcare insurance plans.

5. Working knowledge of hospital clinical departments and service protocols.

6. General knowledge of hospital payment plan guideline.

7. General knowledge of healthcare coding practices.

8. General knowledge of hospital clinical departments and services protocols.

9. Experience and knowledge in admissions, registration, and insurance verification.