Prior Authorization and Scheduling Representative

POSITION SUMMARY

The Prior Authorizations and Scheduling Representative is responsible for the pre-registration of patients to the hospital for medical services offered by Humboldt General Hospital departments such as Radiology, Surgery, Infusion, and Physical Medicine. This function is heavily involved in patient and interdepartmental interactions via telephonic conversations, wherein information collection and communication regarding patient demographics, insurance benefits and financial requirements, and medical service orders to ensure accuracy and compliance are of the highest priority.

TASK LETTER CODE

PRIMARY DUTIES

(Are the essential job tasks or primary responsibilities that the individual who holds the position mist be able to perform unaided or with the assistance of an accommodation. For example: “DO” (action verb) “WHAT” (object) – “Collects vitals from patients at the being of the visit according to clinic protocol”.

% OF TIME PERFORMING DUTY

A

Performs pre-registration ensuring that patient demographics and insurance coverage are verified, and all details are accurate and updated

B

Obtains updated copies of insurance cards, driver’s license, and referrals/authorizations when applicable. This includes detailed documentation of prior authorization approvals in the electronic medical records system, including proper scanning of approval/denial letters from insurance carriers and completed HGH Authorization Request Form.

C

Reviews structured clinical data matching it against specified medical terms and diagnosis and procedural codes (without the need for interpretation) and follow established procedures for authorizing requests or referring requests for further review by ordering providers or insurance carriers before final scheduling.

D

Calls patients to explain the medical services to be done including a detailed review of preparations needed and presents the next steps of the process if financial liabilities are applicable.

E

Coordinates with various hospital departments regarding patient appointment guidelines on scheduling, overbooking, and appointment types.

F

Determines the appropriate questionnaires required for exams/procedures and provides clear instructions to every patient prior to their visit.

G

Schedules appointments for medical services/exams/procedures and updates schedules based on cancellations or timing changes; keeps departments updated of adjustments done in a timely manner.

H

Answers incoming telephone calls regarding status of prior authorizations and scheduling of medical services.

I

Establish effective and professional rapport with other employees, support staff, customers, clients, patients, families, and physicians.

J

Actively supports departmental and organizational strategic plans and ensures successful implementation of assigned initiatives.

K

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

L

Other related duties as assigned.

POSITION QUALIFICATIONS

MINIMUM EDUCATION: High School Diploma

PREFERRED EDUCATION:

MINIMUM EXPERIENCE: One (1) year relevant experience. Experience in a medical office or hospital setting preferred.  

REQUIRED CERTIFICATIONS:

PREFERRED CERTIFICATIONS/LICENSES:

SPECIAL SKILLS: Excellent customer service, strong written and oral communication skills required; Knowledge of medical and insurance terminologies preferred; Able to handle multiple tasks and interdepartmental coordination simultaneously

SUPERVISES: None.

PHYSICIAL DEMANDS: For physical demands and working conditions, see next page.