JOB SUMMARY: 

Under general supervision, performs patient scheduling functions and checks out duties in addition to a significant amount of higher-level work. Higher-level work may include a combination of TES (transaction editing system) duties, medical coding, lead responsibilities, financial coordination, etc. 

EDUCATION/EXPERIENCE: 

High school diploma or GED equivalent with three years' clerical experience, six months of which must be at the Patient Scheduling Coordinator level or equivalent. Knowledge of third party payor requirements. Basic knowledge of ICD-9 and CPT coding or willingness to complete these courses upon employment. Data entry accuracy of 5000 kph with 3% or less error rate. LICENSURE, CERTIFICATION, and/or REGISTRATION: Completes certification program and maintains accuracy standards. Basic Cardiac Life Support required within 30 days of hire.

ESSENTIAL FUNCTIONS: 

1. Schedules clinical appointments for new and returning patients with independent judgment and discretion. Follows Clinical Operations standards to promote a cooperative work and patient care environment. 

2. Coordinates extensive laboratory work and diagnostic testing for patients. Anticipates necessary lab work and testing based on knowledge of patient needs. 

3. Completes scheduling information promptly with 97% accuracy, including patient demographics, insurance information, employer information, emergency contact information and other required data. Asks patient to verify accuracy of registration data. 

4. Enters and verifies insurance information in IDX. Interacts with insurance companies for benefit verification as required. Determines if referrals or prior authorizations are required. 

5. Makes daily judgments over the telephone as to the timeframe in which patients should be seen based on experience and the examination of patient charts. 

6. Calls in prescriptions for physicians, as instructed. Processes transaction editing system (TES) files by obtaining requested information. Performs medical coding as needed to assure proper billing for services rendered. 

7. Performs complex coordination among WFUHS physicians, external physicians, patients, nurses, and outside testing laboratories to assure that all necessary tests are performed and paperwork is complete. Coordinates departmental consult service as directed. 

8. Performs IDX schedule maintenance based on provider needs. 

9. Assures that each patient chart is fully prepared prior to the visit, all tests are ordered, and special patient needs have been anticipated. Coordinates testing for inpatients, using judgment and discretion as to the seriousness of condition to properly plan for transportation, timeframe of tests, and types of test performed. 

10. Answers inquiries concerning clinic policies and procedures. Initiates and facilitates the resolution of patient issues and complaints utilizing other Medical Center professionals as needed. Practices excellent customer service skills. Accommodates patient's special needs (e.g., interpreter). 

11. Coordinates surgeries using discretion as to timeframes, instruments needed, room availability, and physician schedule. Obtains pre-certifications and coordinates activities with NCBH as required. 

12. Performs financial duties such as authorizing or obtaining authorization for insurance, reviewing encounter forms, assisting with medical coding, providing assistance to patients regarding billing questions, etc. 

13. Assists in the training of less experienced personnel as instructed. Completes required educational programs to remain current on job responsibilities and fulfill compliance requirements. Successfully completes the WFUP Certification Program. Attends and participates in the development of the WFUP Clinical Operations Departmental meetings regularly. 

14. Performs other related duties incidental to the work described herein. 

SKILLS/QUALIFICATIONS: 

Ability to function independently in an intensive clinical setting Ability to perform multiple tasks simultaneously Experience using IDX, Medipac and LastWord Experience with managed care or Health Insurance Company