Central Scheduling and Authorization Representative

JOB SUMMARY: 

Under the direction of the Central Scheduling Supervisor, performs scheduling, pre-registration, insurance verification, patient financial responsibility and precerts on all applicable patients. Exhibits the F.I.R.S.T. values (Friendliness, Innovation, Respect, Service and Trust).

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

1. Works closely with all departments to accurately obtain all applicable information for inpatients, observations, surgeries, and specific outpatient testing such as radiological procedures. The purpose of this function is to pre-register and verify all insurance pertaining to the patient’s account to ensure proper payment.
2. Has the ability to efficiently and effectively work with physician office personnel to provide the patient via the office call the appropriate test at a suitable time. Obtains treatment order, diagnosis, authorization and MD signature. Facilitates collection of prior to patient presentation.
3. Uses the scheduling module of the hospital information system to make timely and accurate entries into the system.
4. Pre-registers, organizes and distributes all needed information and materials to surgery pre-op.
5. Ensures that payment arrangements are made prior to surgical procedures.
6. Develops and maintains a strong working team relationship with all physicians and physician offices to ensure the proper collection of insurance and demographic information at the time of scheduling and pre-registration.
7. Uses knowledge of scheduling protocols including times, sequence, days of the week, length of procedures to ensure sequencing of test and a high degree of accuracy.
8. Expedites the registration and billing process by ensuring the accurate collection of insurance, patient information & precerts.
9. Monitors orders received thru the e-mail systems to properly distribute to proper departments
10. Verify insurance coverage/co-pay amounts by an on-line vendor or by manual phone call for all applicable services and informs patients of expected payment amounts due at time of registration.
11. Works with patients, physicians and insurance companies to ensure all pre-certifications and verifications are obtain before services are rendered and applicable.
12. Maintains a complete working knowledge of all insurance, managed care, third party and governmental insurance plans including Medicare Secondary Payers.
13. Works with Case Management on hospital admissions, observation and SNF patients to ensure proper insurance authorization and coverage.
14. Must be able to work independently and deal with stressful situations when scheduling and verifying information with patients.
15. Demonstrates a commitment to professional accountability and growth to maintain and expand knowledge and skills.
16. Contributes to the achievement of the mission and philosophy of the Organization.
17. Contributes to the effective operation of the Organization by demonstrating dependability in job performance.
18. Demonstrates a commitment to incorporating the core concepts of patient family centered care into practice (dignity, respect, information sharing, and participation).
19. Demonstrates a commitment to the development and implementation of shared governance across the Organization.
20. Performs other related duties as assigned.

WORKING CONDITIONS, HAZARDS AND PHYSICAL EFFORT:

Regular work schedule with little or no overtime. Small work station area with above average levels of noise. Minimal physical exertion, some stooping and bending required. Must be able to work with interruptions. The task of this job does not involve exposure to blood, body fluids, or tissue. Must be able to move or position 25 lbs. independently.

CONTACTS WITH OTHERS:

Has contact with patients, visitors, Associates, physicians, and physicians’ staff. Must be able to use tact and diplomacy in dealing with individuals when explaining processes, procedures and clarifying information.

EQUIPMENT USED/SPECIAL SKILLS REQUIRED:

Data entry and calculator skills required. Excellent communication (written/verbal) skills a must. Uses personal terminals, copy, fax machine and computer printers.

Previous scheduling experience with knowledge of Medical Terminology preferred. A minimum of one (1) to three (3) years experience working in hospital or medical environment; or scheduling or insurance related field with customer service experience or similar working knowledge for this position.