Centralized Scheduling Coordinator

The Pre-Authorization and Centralized Scheduler is responsible for coordinating and scheduling surgeries, procedures, and appointments. This role ensures accurate entry of orders, verifies insurance, secures prior authorizations, and informs patients and providers of necessary pre-procedural requirements. The position plays a critical role in facilitating seamless care delivery, supporting insurance compliance, and ensuring an exceptional patient experience.

Qualifications

Education/Experience:

Required:

• High school diploma or equivalent
• Minimum three (3) years of healthcare-related work experience

Preferred:

• Associate’s or Bachelor’s degree in a health-related field

Responsibilities

• Communicate with patients regarding scheduling, authorizations, insurance statuses, and preparation requirements

Scheduling and Coordination:

• Schedule appointments, tests, surgical procedures, and pre-operative clearances
• Communicate appointment details and pre-procedure instructions to patients and provider offices
• Select appropriate surgical instruments and supplies in coordination with clinical teams
• Coordinate all specialty pre-op clearances (e.g., PAT, PCP, cardiology)

Order Management & Documentation:

• Enter electronic orders promptly and accurately
• Verifies written physician orders, documentation, and equipment needs
• Finalizes and ensures informed consent documentation is complete
• Confirms patient identification, demographics, symptoms, HIPAA forms, and insurance details

Prior Authorization Duties:

• Review medical documentation to determine medical necessity for treatments and procedures
• Submits accurate and complete prior authorization requests to insurance companies

• Maintains and tracks detailed insurance records for authorization status (approvals, appeals, and denials)

• Acts as a liaison between healthcare providers, billing department, authorization teams, and patients by maintaining active communication, resolving issues, following up on pending requests, handling denials, and informing patients of authorization statuses and explains any delays or denials as needed
• Prepares appeal documentation and schedules/support peer-to-peer insurance review processes
• Manages auto insurance claims related to surgical procedures

Financial and Insurance Verification:

• Collect patient insurance information, co-pays/self-pay balances, and complete necessary registration fields to assist on-site registration teams
• Coordinate with Patient Accounts to confirm financial clearance, including for self-pay patients

Additional Duties:

• Manages procedure scheduling and urgent prior auth requests.
• Prepares, initiates, and transmits referrals to external and internal providers for specialty consultations
• Prepares, initiates, and transmits ancillary studies.
• Participates in special projects, committees, or quality improvement efforts, as applicable to the department.

HIPAA: This position will have access to the Protected Health Information described below, in order to carry out the duties related to the position at Hays Medical Center, based on the following criteria:

• Primary – required (routine) to do the job;
• Secondary – required for the job, but mostly by exception; and
• None – no approved access

Description of Information:

• • Primary
    • Coding Information (clinical information that is in (alpha) numeric format): ICD-9 Codes, Rev Codes, CPT Codes
    • Clinical Information (information that describes a patient’s health status): Diagnosis, Reports/Medical Notes, Test Results, Problem List, Procedures, History and Physical
    • Patient Demographic Information (information used to identify a person): Name, Date of Birth, Address, Race, Marital Status, Religion
    • Financial Information/Insurance (information related to insurance, billing, and payment): Billing Information, Payer Name, Payer ID, Account Balances, Plan Elements Covered, Payment Information, Payment Rates

Infection Control: This position will include initial and ongoing training in dealing with infection control. Training could include, but is not limited to, blood-borne pathogens, bodily fluids, and biohazardous materials, as it applies to your daily work environment.

Patient Interaction: Frequent