POSITION SUMMARY
This role involves coordinating and managing or various outpatient services such as; radiology, surgery, infusion therapy, wound care and physical therapy. Responsibilities will include but not limited to; efficient and accurate scheduling of appointments, insurance verification, submission of authorizations for various services including radiology, surgery, infusion therapy, wound care, physical therapy and for all providers who service La Paz Regional Hospital and Clinics. Utilizing a combination of web portals, faxing and phone submissions, you will ensure timely approvals while meticulously tracking the status of authorizations. Effective communication with clinics and central scheduling team is essential to relay any scheduling and authorizations updates promptly. Additionally, this role entails facilitations referrals to specialist. This role demands a combination of technical proficiency, strong organization skills, and effective communicating to enhance patient care and departmental efficiency.
CORE FUNCTIONS
1. Efficiently schedule a wide range of appointments provided by La Paz Regional Hospital and Clinics.
2. Communicate with patients to gather essential information, explain appointment procedures, and answer any questions or concerns regarding their upcoming appointment(s).
3. Address and resolve scheduling conflicts, appointment changes, and patient concerns in a timely and professional manner.
4. Verify patient’s insurance coverage and eligibility, calculate patient liability estimates, explain and collect patient financial responsibility and provide patients with facilities payment options
5. Obtain prior authorizations for a variety of services such as radiology, surgery, infusion therapy, wound care, and physical therapy.
2. Utilize web portals, faxing and phone submissions to complete authorization requests accurately and promptly.
3. Ensure adherence to insurance company guidelines and requirements throughout the authorization process.
4. Manages and tracks the status of all authorization request to ensure timely approvals.
6. Act as liaison between clinics, insurance companies, and the central scheduling team to facilitate efficient authorization process.
7. Facilitate the referral process for patients requiring specialist care, ensuring accuracy and timeliness.
8. Collaborate with healthcare providers to gather necessary documentation and information for authorization and referral submission.
9. Demonstrate a comprehensive understand of insurance policies, procedures and coverage criteria.
10. Stay informed about changes in insurance regulations and requirements relevant to prior authorization and referrals.
11. Ensure accurate and confidential handling of medical records and patient information in compliance with HIPAA regulations
12. Ability to handle difficult situations, manage conflicts and find solutions to patient concerns.
13. Work in a fast-paced environment with changing priorities and occasionally high-stressed situations.
MINIMUM QUALIFICATIONS
High school diploma/GED or equivalent working knowledge.
Requires knowledge of patient financial services, financial, collecting services or insurance industry experience processes normally acquired over one or more years of work experience. Requires the ability to manage multiple tasks simultaneously with minimal supervision and to work independently.
Requires strong interpersonal, oral, and written communication skills to effectively interact with a wide range of audiences. Strong knowledge in the use of common office software, word processing, spreadsheet, and database software are required.
Exceptional organizational skills and attention to detail.
Ability to work efficiently under pressure and prioritize tasks effectively.
PREFERRED QUALIFICATIONS
Certification in Healthcare Insurance and or prior authorization processes.
Previous experience with Patient Access.
Familiarity with medical billings and coding procedures.