Pre-Authorization & Scheduling Specialist

Work Status:

Full-time | 40 Hours per week

Shift Details:

M-F Daytime Department:

Patient Access Job Summary The Pre-Authorization and Scheduling Specialist is responsible for obtaining pre-certifications and pre-authorizations for procedures, diagnostic testing and medications prior to services being rendered. They will also schedule appointments for outpatient clinics and coordinate patient appointments/orders. They will work closely with and act as a liaison to medical, clinical, and billing staff. They will be responsible for communication with insurance carriers and/or providers for purposes of obtaining approval for services requiring pre-certification and/or prior approval for treatment using web-based tools and other electronic means where possible or by telephoning and faxing when necessary. Coordinating those visits with the correct paperwork and insurance verification, along with accurate documentation in the patient's medical record is essential. Essential Functions Proficient with hospital registration and ancillary computer systems. Register the patient, verify their insurance, check eligibility, determine benefits, scan and retrieve documents in the imaging system. Take payments and print receipts etc. Start conversations regarding patient financial obligations, financial assistance and payment plans. Work closely with financial counselor and/or patient accounts staff. Secure authorization on all patients for ancillary, surgical and outpatient testing/procedures. Contact insurance carriers to verify patient's insurance eligibility, benefits and requirements. Obtain accurate insurance information and communicates with patient and/or physician office staff. Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services. Keep up to date with payer policy changes and educate affected staff. Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations. Maintain thorough understanding of various types of payers, and financial class, as well as primary vs. secondary. Communicate with clinical and medical staff to inform them of any restrictions of special requirements in accordance with the patient's particular health plan. Upload medical record information to insurance carriers as requested. Run and ensure medical necessity is complete with proper CPT and ICD-10 codes. Work closely with the physician office staff to ensure that pre-cert/pre-authorization numbers are obtained and entered into the HER. Update patient demographics and insurance information as necessary. Review processes and audit authorization and medical necessity denials. Be able to give excellent customer service to both patients and fellow employees, even in adverse situations. Skills must include empathy and compassion. Basic understanding of the Revenue Cycle, including registration, scheduling, referrals, authorizations, benefits and eligibility. Understand all expected job outcomes and display personal accountability at all times in order to meet all commitments. Attention to detail and accuracy, to achieve outcomes consistent with the specific job requirements. Perform other related duties as assigned.

Education:

High school diploma or equivalent required. Certified Healthcare Access Associate (CHAA) Certification or equivalent required.

Experience:

One-year medical billing/ prior authorization or equivalent preferred. Prior experience in a business office or customer service setting. Knowledge of

CPT, ICD-10

coding and/or medical terminology preferred. Join Providence Medical Center and become part of a collaborative and supportive team dedicated to delivering quality patient care. We offer competitive compensation with shift differential, a complete benefits package with low-cost health insurance, opportunities for advancing education, certifications, and training, and the chance to help shape the future. As a PMC employee, you will also receive a free membership to our Wellness Center and a Retirement Plan with employer match contributions. Guided by our mission of providing quality healthcare in the Spirit of Christ, we strive to be the hospital and employer of choice, living our values of H onesty, E xcellence, A ccountability, R espect, and T eamwork. Pre-Authorization & Scheduling Specialist 1200 Providence Road, Wayne, NE 68787

Full-time Full-time Work Status:

Full-time | 40 Hours per week

Shift Details:

M-F Daytime Department:

Patient Access Job Summary The Pre-Authorization and Scheduling Specialist is responsible for obtaining pre-certifications and pre-authorizations for procedures, diagnostic testing and medications prior to services being rendered. They will also schedule appointments for outpatient clinics and coordinate patient appointments/orders. They will work closely with and act as a liaison to medical, clinical, and billing staff. They will be responsible for communication with insurance carriers and/or providers for purposes of obtaining approval for services requiring pre-certification and/or prior approval for treatment using web-based tools and other electronic means where possible or by telephoning and faxing when necessary. Coordinating those visits with the correct paperwork and insurance verification, along with accurate documentation in the patient's medical record is essential. Essential Functions Proficient with hospital registration and ancillary computer systems. Register the patient, verify their insurance, check eligibility, determine benefits, scan and retrieve documents in the imaging system. Take payments and print receipts etc. Start conversations regarding patient financial obligations, financial assistance and payment plans. Work closely with financial counselor and/or patient accounts staff. Secure authorization on all patients for ancillary, surgical and outpatient testing/procedures. Contact insurance carriers to verify patient's insurance eligibility, benefits and requirements. Obtain accurate insurance information and communicates with patient and/or physician office staff. Request, track and obtain pre-authorization from insurance carriers within time allotted for medical and services. Keep up to date with payer policy changes and educate affected staff. Demonstrate and apply knowledge of medical terminology, high proficiency of general medical office procedures including HIPAA regulations. Maintain thorough understanding of various types of payers, and financial class, as well as primary vs. secondary. Communicate with clinical and medical staff to inform them of any restrictions of special requirements in accordance with the patient's particular health plan. Upload medical record information to insurance carriers as requested. Run and ensure medical necessity is complete with proper CPT and ICD-10 codes. Work closely with the physician office staff to ensure that pre-cert/pre-authorization numbers are obtained and entered into the HER. Update patient demographics and insurance information as necessary. Review processes and audit authorization and medical necessity denials. Be able to give excellent customer service to both patients and fellow employees, even in adverse situations. Skills must include empathy and compassion. Basic understanding of the Revenue Cycle, including registration, scheduling, referrals, authorizations, benefits and eligibility. Understand all expected job outcomes and display personal accountability at all times in order to meet all commitments. Attention to detail and accuracy, to achieve outcomes consistent with the specific job requirements. Perform other related duties as assigned.

Education:

High school diploma or equivalent required. Certified Healthcare Access Associate (CHAA) Certification or equivalent required.

Experience:

One-year medical billing/ prior authorization or equivalent preferred. Prior experience in a business office or customer service setting. Knowledge of

CPT, ICD-10

coding and/or medical terminology preferred. Join Providence Medical Center and become part of a collaborative and supportive team dedicated to delivering quality patient care. We offer competitive compensation with shift differential, a complete benefits package with low-cost health insurance, opportunities for advancing education, certifications, and training, and the chance to help shape the future. As a PMC employee, you will also receive a free membership to our Wellness Center and a Retirement Plan with employer match contributions. Guided by our mission of providing quality healthcare in the Spirit of Christ, we strive to be the hospital and employer of choice, living our values of H onesty, E xcellence, A ccountability, R espect, and T eamwork.