Description

This is a full-time non-exempt position of 40 hours a week, 8 hours per day working within normal business hours of 8am-5pm, Monday-Friday. This position requires a rock start who can work independently or cross-functionally with the ability to have make good judgment, multitask, problem solve, prioritize tasks, and provide excellent customer service. Must be able to work in a fast-paced, changing environment with a solid understanding of payer reimbursement policies to include interpreting CPT/Diagnosis codes to decide covered procedures from experimental, investigation or non-covered procedures. Must have the ability to translate and convert surgery orders to an actual surgery within 8 weeks of consultation/order following facility anesthesia and internal protocols using HIPAA compliant communication to meet KPI.

Scheduling 

• 80% surgery utilization at each facility for each surgeon with high goal of 85%. 
• Greater than 97% accuracy of dropping unused block time within 14 days.
• Greater than 97% accuracy of order and surgery, pre, and post appointment status following note templates (What, When, Where, why, and how).
• Greater than 97% accuracy for booking scheduled surgery or procedure.
• Greater than 97% accuracy for preop paperwork/equipment within 7 business days of surgery (CT, medical clearance, etc.). 

Revenue Integrity 

• Greater than 97% accuracy for verification of benefits (VOB) and authorization for both insurance and patient financial reimbursement to include note template (What, When, Where, why, and how). 
• Greater than 97% of verification, authorization, denial, and appeal attachments uploaded to patient’s accounts. 
• Verification of Benefits (VOB) completed within 3 business days of order, and authorization completed and/or follow up within 7 business days of order. If an authorization appeal or peer to peer is needed, then the appeal or peer to peer is within 3 business days of denial or request.
• Insurance: Greater than 97% accuracy of Payment Plan at time of scheduling and/or 100% payment collected within 14 business days of surgery for insurance
• Self-Pay - this includes non-covered, investigational, experimental, or cosmetic even if patient has insurance: Greater than 97% for collection of 50% payment of total surgery cost at time of surgery and 100% payment collected 4 weeks before surgery.

Requirements

EDUCATION and/or EXPERIENCE 

• High school diploma or general education degree (GED). 
• 2 years of related experience. 
• Medical Terminology, Medical Coding & Documentation, Medical Billing or Scheduling experience a plus.

LANGUAGE SKILLS 

Ability to read and interpret documents such as safety rules, use and maintenance instructions, and procedure manuals. 

COMPUTER SKILLS 

Must have computer knowledge of basic programs such as Microsoft Word and Google programs.