Description

This position will be responsible for coordination of scheduling outpatient diagnostic ancillary procedures through interviews by telephone or in person of patients and/or families or other representatives such as Physician office personnel to obtain necessary scheduling information. This position will also be responsible for verify inpatient and observation insurance coverage and securing authorizations. Maintains current knowledge of insurance authorization and coverage requirements, ensuring all relevant procedures have proper authorization/certification details in place prior to the date of service. Records all the required information into the scheduling system computer.

Job Results & Essential Functions

Scheduling

1. Schedules patients for diagnostic testing and infusion, as ordered by referring physicians (generally via telephone).
2. Informs patients and/or physician's staff of proper preparation and instructions for tests ordered and any pre-certifications they need to acquire.
3. Pre- Register/registers patients who have been referred for out-patient and inpatient services, when applicable.
4. Prepares appropriate paperwork for the service and retains orders (requisitions) for all scheduled appointments via fax and scans them into corresponding patient accounts.
5. Maintains effective communication with physician's offices and ancillary departments within the hospital.
6. Performs insurance authorization and benefit checking on all inpatient, observation, infusion, ambulatory surgery, and imaging services. Refers u report daily to verify that scheduled tests were ordered and done according to the authorization obtained. Calls insurance company to request code change when the department/radiologist changes the test that was authorized.
7. Runs insurance authorization report daily to verify that scheduled tests were ordered and done according to the authorization obtained. Calls insurance company to request code change when the department/radiologist changes the test that was authorized.
8. Meets with patients to assist in obtaining information and documents needed for charity care applications.
9. Reports as needed to the Director and/or supervisor any issues that may affect reimbursement.

Requirements

Education & Experience

Minimum high school diploma with 3-5 years of experience in a health care setting.
Excellent customer service and grammar skills needed. Familiarity with various insurance plans helpful.

Licenses and/or Certifications

NA

Skills

• Strong ability to engage individuals from a diverse background.
• Must demonstrate good interpersonal skills as well as verbal and written communication skills.
• Experience with multiple systems, including but not limited to MS Word, Excel, and Power Point
• Must be detailed oriented, have strong analytical skills and be passionate about customer service.
• Ability to maintain composure in stressful situations.
• Capacity to operate with significant independence, self-motivation, empathy and acceptance of and interest in a diverse client population.
• Knowledge of CMS and AHCCCS and other payer remits to accurately post payments, adjustments and denials.
• In depth knowledge of third party payer reimbursement policies.

Language Ability

Ability to read, write and interpret documents in English such as safety rules, operating and maintenance instructions and procedure manuals. Ability to read, analyze and interpret common scientific/trade/technical journals. Ability to respond to common inquiries or complaints from customers, or regulatory agencies.

Math Ability

Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions and decimals. Ability to calculate figures and amounts such as proportions, percentages, rates and ratios.

Reasoning Ability

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

Physical Demands

Bending, reaching and sitting for extended periods of time.

Working Conditions

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. Prolonged sitting, computer operation.

This job description is a summary of the job duties and requirements that represent the general nature and level of work being performed. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. This description is not intended to limit or in any way modify the right of management to assign, direct and control the work of employees. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. All employees are expected to understand and adhere to the Standards/Code of Conduct and the Corporate Compliance Plan as well as ensure that all educational requirements related to Corporate Compliance are implemented and adhered to as required by the CCP Education Plan, in addition to compliance with organizational policies and procedures, regulatory expectations, quality and department standards, etc.