Monday - Friday, 08:00am to 4:30pm
JOB SUMMARY
The Pre-Registration-Scheduler is a critical role within the Patient Financial Services and Revenue Cycle team. This position serves as the primary point of contact for patients and provider offices, ensuring that all outpatient services—ranging from Radiology, Surgery, Respiratory Therapy and NTMC clinics —are scheduled efficiently while maintaining strict regulatory and financial compliance.
SUMMARY OF ESSENTIAL JOB FUNCTIONS
Pre-Registration and Data Integrity
- Collect and verify patient demographic and insurance information prior to the date of service.
- Before the encounter is finalized, analyze and resolve live quality metrics by modifying patient records in Medhost.
- Utilize and maintain the Pre-registration-Scheduling worklist database to track GFE status, authorization details, and provider notes.
- Ensure Patient Control Numbers (PCNs) are created only when a patient is ready to be moved forward with scheduling.
- Manage patient intake and consent forms through digital platforms such as Simple Interact, ensuring duplicate consents are minimized and rescheduling is reflected accurately in the database.
Insurance Verification and Authorization
- Conduct comprehensive insurance verification and check for automated responses within the Medhost system.
- Obtain necessary prior authorizations and verify medical necessity for scheduled procedures.
- Collaborate with provider offices to correct orders when the wrong compendium is selected or clinical documentation is missing.
- Maintain knowledge of the current payor grid, including new agreements such as Healthcare Highways.
Centralized Scheduling and Coordination
- Coordinate scheduling for various modalities including Radiology (MRI, CT, Ultrasound, Mammography) and Surgical procedures.
- Manage outpatient testing schedules for Respiratory Therapy (EKGs, PFTs, ABGs), strictly adhering to the established scheduling windows to accommodate inpatient rounds.
- Proactively contact patients whose orders have been faxed to schedule appointments, thereby reducing walk-ins and ensuring staff availability.
- Monitor and aim to reduce Turnaround Time (TAT) from the receipt of an order to the finalized scheduled appointment.
Regulatory Compliance and GFE Management
- Strictly follow No Surprises Act and/or Regulatory protocols regarding Good Faith Estimates (GFEs) for self-pay patients.
- Identify self-pay patients during the scheduling phase and assess GFE requirements:
- Prioritize scheduling before transferring calls to financial counseling to ensure regulatory timelines are met.
Patient Communication and Service
- Explain the ordering and authorization process to patients and provider staff to manage expectations regarding wait times and scheduling protocols.
- Inform patients of insurance denials or medical necessity failures and offer alternative options such as MDSave.
- Maintain a professional "Express Check-In" experience by ensuring all paperwork and financial counseling are completed before the patient arrives.
BASIC SKILLS
- Attention to detail and ability to handle multiple priorities
- Proficient use of computers including email and spreadsheet management
- Experience and proficient use of medical terminology and health information systems (ex. Medhost, Athena)
- Experience with digital intake systems (ex. Simple Interact)
- Excellent customer service skills with a commitment to service
- Prefer certification as a Certified Healthcare Access Manager (CHAM) or as Certified Revenue Cycle Specialist (CRCS)
EDUCATION AND EXPERIENCE
- High School diploma or equivalent
- Associates degree or higher preferred
- Prefer 1 to 2 years of experience in Revenue Cycle, Patient Access or Centralized Scheduling in an acute care setting
LANGUAGE SKILLS
- Ability to communicate effectively both verbally and written.
- Additional language is a plus
PHYSICAL REQUIREMENTS
- Must be able to sit for extended periods of time.
- Ability to bend, stoop and reach overhead.
- Must be able to lift 25 pounds
