POSITION STANDARDS 3

years of experience with rehab services High School diploma or equivalent; Associates degree Effective interpersonal/communication skills Profcient with computer applications, including data entry software, word processors, and reporting Ability to coordinate and prioritize multiple tasks at once

POSITION PHYSICAL REQUIREMENTS

Anything listed here requires a pre-employment physical by Employee Health to determine if the employee is capable of meeting the requirements.

Physical Activity:

Sitting for the entire work day (4-8hrs) using a computer and two screens, simultaneously using telephone headset and performing continuous keyboarding.

Upper Extremity:

Bending, reaching and standing may also be required at times.

Push/Pull/Lift/Carry:

PART TWO

FUNCTIONAL

RESPONSIBILITY

Position Objective Provides administrative and scheduling support with a focus on prior authorization for routine and specialty clinic appointments. Performance Expectation Maintains overall insurance and self-pay related processes and systems for the rehab outpatient clinic to ensure and track accurate patient coverage info and accurate Maintain tracking system and processes for all recertifications for outpatient with Medicare insurance. Prior authorizations and referral management Communicate with payors via internet, telephone and fax for coverage and authorization processes Enter limitation and authorization requirements and limits into referral. Monitor visit limit countdown via system reports Appeal pre cert denials Maintain access to insurance provider portals as well as keep current forms for authorization requests. Documents all patient communications and relevant information in the referral per established clinic guidelines. Determine patients' responsibility for non-covered procedures, therapies, coinsurance as appropriate - facilitates providing an estimate upon request and ABNs as needed. Assess the need for and offer to refer patients to Patient Financial Services when needed. Explain coverage limits in person, via telephone or myDH . Maintain a current list of applicable charge codes and prices to support self-pay patients. Full understanding of scheduling process and how it interfaces with insurance auth Actively participates in administrative duties that support patient access and patient satisfaction. Maintains scheduling guidelines as it relates to insurance requirements and authorizations. Maintains templates and accommodates patient needs while maximizing available contact hours. Actively manages wait lists and fills open clinic appointments due to cancelations. Actively supports clinic patient needs by scheduling appointments, responding to patient inquiries via telephone, myDH, and in person. Implements and evaluates quality improvement plans and processes to achieve compliance with regulatory and payer requirements Review denial trends with clinical and admin leadership Remain up to date with coverage changes in insurance authorizations, general coverage vs third party billing (telehealth, etc) Support rehab providers with updated information that will inform template changes and reduces denials.

Maintain workqueues:

WQ Account and WQ Claim Edit to correct missing attending Support training and onboarding of staff regarding rehab insurance coordination and scheduling. Performs other duties as required or assigned.

Min:

$19.20

Max:

$29.76

Location:

Alice Peck Day Memorial Hospital •

Rehab Med-Pt Outpatient Schedule:

Full Time, Day Shift, M-F 7am-2:30pm