Scheduler

PART ONE: Dimension and Description

Primary Purpose: To facilitate patient care by obtaining appropriate data to accurately schedule the patient for various ancillary services and specialty clinics and to ensure eligibility and prior authorizations are correctly obtained for such services.

Formal Policy-Setting Responsibilities: Formally responsible for providing input into policies associated with the job’s purpose and essential responsibilities.                                   

Routine Decision Making: Determines scheduling times and dates suitable for appointment; determines adequate insurance information/demographic data; time allowed for each appointment and persons needed to notify; whether or not special provisions need to be made; if insurance requirements are being met.                                       

Formal Supervisory Responsibility: No formal supervisory responsibility.                                

Required Knowledge: Medical terminology; health insurance knowledge; familiarity with medical coding or willingness and ability to learn.                                        

Required Skills and Ability: Excellent communication skill; problem solving; organizational skills; proficiency in keyboarding/computer use, multitasking, critical thinking skills, ability to work 6-8 hours on the computer, and typing and talking on the phone at the same time.  Deal effectively with emotionally charged situations.                                              

Unusual Working Conditions: None                                         

Education and Certification/ Registration required for the Position: High school education.

PART TWO: Essential Responsibilities and Tasks

A.            Collaborates with hospital staff, outreach staff, PCP offices, insurance companies, patients and all other clients to provide patient scheduling. (40% of time)                                                       

1.            Answers phone calls from physician offices, hospitals and patients and all other clients using exemplary customer service skills.                                           

2.            Accurately enters required information into computer base.                                                       

3.            Maintains patient confidentiality as defined by state, federal and company regulations.                  

4.            Establishes effective rapport with other employees, professional support service staff, customers and everybody else they communicate with.               

5.            Actively supports the values of Cass Regional Medical Center to ensure an exceptional customer experience.

6.            Communicates information about the surgical progress to the patient’s family/significant other in the waiting room as directed. Takes and records messages and communicates to appropriate medical staff.

B.            Verifies eligibility, benefits and authorizations, referrals for all ancillary scheduled procedures and Pain Clinic appointments. (50% of time)                                                     

1.            Verifies insurance eligibility and benefits on selected clinics and ancillary procedures.                     

2.            Requests and/or obtains referrals and authorizations, and is responsible to verify the CPT codes and effective dates for all authorizations/referrals received.                                                

3.            Notifies patient and ordering practitioner of non-covered benefits, or inability to obtain authorization.                                                               

4.            Provides insurance companies with appropriate clinical records to obtain authorizations.               

5.            Enters proper documentation of conversations with patients, insurance companies and other staff regarding authorization, coverage and/or denials.

6.            Notifies Nurse Manager and anesthesia provider of any changes in surgery lineup. If schedule is already distributed, notifies appropriate departments.

7. Serves as intermediary on add on’s or urgent services to ensure authorization.

8. Verifies status on orders and allowable inpatient versus outpatient on surgery authorizations in addition to complying with CMS Inpatient Only List.

C.            Performs medical necessity checks on scheduled ancillary procedures. (5% of time)                          

1.            Performs medical necessity checks daily and obtains correct diagnosis to pass the check by looking through all available medical records and/or calling the ordering physician’s office for assistance.

D.            Other duties as assigned. (5% of time)   

Previous experience in hospital setting scheduling, pre authorizations, and eligibility. Preferred experience specialty to surgery.