REHOBOTH BEACH, Delaware
Posted: 03-Jun-23
Location: Lewes, Delaware
Salary: Open
Categories:
Internal Number: 8639
Summary: Under general supervision, this individual is responsible for scheduling patients, collecting demographic and insurance information. Verifying Insurance eligibility and benefits, obtaining authorization and referrals as required for scheduled outpatient exams.
Other information: Comprehensive medical and insurance terminology. Comprehensive knowledge of medical insurance plans, and managed care plans.1 year experience previous registration/admitting and/or physician office experience. Prior scheduling experience , insurance verification/authorization experience preferred. Working knowledge of healthcare registration, insurance referral and authorization processes. Ability to communicate with physicians offices, patients and insurance carriers in a professional and courteous manner.
Responsibilities: Initiates and tracks referrals, insurance verification and authorizations for all outpatient encounters . Utilizes third party payer websites and telephone to retrieve coverage eligibility , authorization requirements and benefit information to include copays and deductibles. Works directly with physicians office staff to obtain clinical data needed to acquire authorization from carrier. Inputs information online or calls carrier to submit request for authorization, provides clinical back up for test and documents approval or pending status. Follows up on any pending status authorizations. Documents insurance coverage restrictions, referrals, benefits and authorizations in SCI scheduling notes. Completes Insurance verification form. Inputs authorization numbers, CPT codes and date spans into Invision and OAS Gold. Identifies issues and problems with referral/insurance verification processes, analyzes current processes, and recommends solutions and improvements. Reviews and follow up on authorization wordlists for all payors. Coordinates and schedules services for patients of physicians in the authorization program. Provides departments with physician orders and other requested information. Researches delays in service and discrepancies of orders. Monitors fax machine to retrieve orders and requests for tests to be scheduled. Assists lead, manager & financial services staff with denial issues by providing accurate supporting data. Initiate appeals and request reviews with the Medical Director to overturn denials. Obtains additional clinical information as needed to support testing requested . Advises physicians of Medical Review decisions and work with physicians to get approval. Reviews Medicaid, Blue Cross and Commercial carrier daily wordlists to insure that authorizations from non participating physicians are documented, validates with carrier that correct CPT codes are authorized. Insures that CPT codes match exam that is ordered by physician. Pre- registers patients to obtain demographic and insurance information necessary for registration , insurance verification , authorization, referrals and bill processing. Demonstrates proficiency with scheduling guidelines , departmental protocols, insurance matrix and authorization requirements. Demonstrates proficiency in scheduling studies for diagnostic imaging, non invasive cardiac testing, cardiac cauterizations, vascular testing, pulmonary studies, EEG, and rehab evaluations and treatments. Assist in care and maintenance of equipment and supplies. Alerts lead to malfunction of equipment and/or call for maintenance/repair. Develops and maintains a good working rapport with interdepartmental personnel such as; ancillary departments, physician offices and financial services. Performs other duties as assigned.
Competencies and skills:
Essential:
* Clear Communication Skills Both Written And Verbal
* Knowledge Of Basic Computer Programs
* Able To Keep Confidential Information Regarding Patients, Team Members
* Able To Withstand Crisis Situations
* Has Skills To Provides Customer Service To Patients, Team Members And Visitors
Education:
Essential:
* High school graduate or equivalent
Location: Hospital-Main Campus
Shift : Flexible-hours/shifts may vary depending on department needs
FTE: 1.000000
Work Status: Full Time