Based out of the Glenwood Springs office. Mon-Fri / 40 hours, full benefits.
The Precertification Specialist / Scheduler will assist in scheduling patient encounters for all clinical service departments using Meditech Scheduling and B/AR module. To act as liaison between Hospital departments to effectively coordinate scheduling of tests and procedures. Responsible for pre-authorization function to assure accurate and timely payor information and fiscal responsibility.
ESSENTIAL FUNCTIONS 50%
I ESSENTIAL JOB DUTIES
Accurately schedules appointments, choosing appropriate appointment types, and correct data entry. Professional & responsive communication with physicians, patients, and departments.
Mammo - interviews & schedules patients using:
symptoms/screening, Insurance/Komen or other Grants, implants, & requests for previous films. Assist Breast Liaison with follow-up. Keeps current on all grant criteria & requirements.
Produces day end reports & distributes. Includes reviewing scanned orders, correct procedure vs. actual order, and ABN if needed has been processed & distributed accordingly.
Works with other PFS staff to ensure fiscal management of appointments. Stays current on Medicare & insurance requirements, ensuring ABN's & insurance waivers & pre-certs
are completed & communicated to patient & scanned.
Understands and complies with all Hospital, patient confidentiality, ABN’s and insurance waivers. Participates in trainings & staff meetings. Reads daily summary reports & emails to be aware of changes.
Fiscal responsibility including reviewing and completing ABN’s, Insurance authorizations/waivers, and ensuring completed precertification as needed.
Schedules and pre-certifies all Physical Therapy patients-at all AVH locations. Reviews and monitors CAP requirements and ABN’s for Medicare patients. Pre-certify and/or check for MCR ABN on all patients with scheduled lab tests-at all AVH locations. As above does all pre-certification, insurance authorizations and waivers, required ABN’s and CAPS.
II SERVICE EXCELLENCE/CUSTOMER SERVICE
Demonstrates purposeful service excellence through exceeding patient and coworker expectations.
Represents the department/hospital as a dedicated, courteous, and responsive employee
III COMPLIANCE WITH RULES, REGULATIONS AND POLICIES
Records pertinent documentation in accordance with regulatory requirements, professional standards and hospital policy.
Adheres to federal, state and hospital rules and regulations concerning HIPAA privacy and security.
Follows Hospital compliance plan and policies, including the Code of Conduct.
Participates in required training for compliance related activities (HIPAA, Compliance, Patient Safety, TJC, etc.)
IV UNIT SPECIFIC DUTIES & RESPONSIBILITIES / DAY TO DAY OPERATIONS
Utilizes computerized scheduling and B/AR modules to maximize benefit for AVH and customers. Adapts software to meet needs.
Provides assistance to other departments as needed.
Demonstrates responsibility and accountability for own professional decision making and professional growth.
Participates and contributes to departmental meetings and activities.
POPULATION SPECIFIC CRITERIA No Rating
Demonstrates the ability to assess and interact with customers of all ages, recognizing language and learning barriers, and technology challenges.
Able to state his/her duties during a code pink drill.
VII CORE VALUES 50%
is passionate about patient care, creating positive impressions on a consistent basis and exceeding our patients’ expectations. Exhibits courtesy and sensitivity to the needs of patients and their families, responds with a sense of urgency to patient problems, anticipates patient requirements, responds proactively and places the patient’s safety above all else.
works collaboratively with physicians and other staff and assists whenever possible. He/she openly shares information, provides feedback and participates in appropriate decision making as part of a team of healthcare professionals. Hospital and departmental objectives are placed ahead of individual agendas
Respect for Others:
actively listens to others, takes other opinions into account, and communicates openly and honestly. He/she demonstrates respect for others by being timely with communications, completion of tasks, and meeting attendance. The employee is respectful of all physicians, colleagues, patients, visitors, and other stakeholders
takes responsibility for his/her actions, abides by the hospital's guiding philosophies and policies, and follows through on commitments and physician orders. He/she provides complete and accurate information to the Physician and/or other members of the work team. takes personal pride and ownership in the quality of care and services provided to all internal and external customers
is truthful, trustworthy, and principled. He/she demonstrates character, conviction, and honest and ethical behavior in all interactions with others. The employee's word can be trusted. Behavior is consistent with these AVH Core Values
KNOWLEDGE, SKILLS & ABILITIES
Medical Terminology required
2-3 years of experience in related healthcare field preferred
KNOWLEDGE AND SKILL REQUIREMENTS
- Ability to concentrate and show attention to detail
- Relatively high degree of analytical abilities
- Strong interpersonal skills required
- Ability to work independently
- Ability to read and communicate effectively in English
- Spanish preferred
- Normal patient care environment with little exposure to excessive noise, dust and temperature
- May be exposed to communicable diseases through normal or careless performance of responsibilities
- May be exposed to mechanical dangers associated with mechanical devices
- May be exposed to stressful situations
DESCRIPTION OF PHYSICAL DEMANDS
On-the-job time is spent in the following physical activities.
Talk or hear:
Use hands to finger, handle or feel:
Push or pull:
Stoop, kneel, crouch or crawl:
Reach with hands and arms:
Taste or smell:
This job requires that weight be lifted or force be exerted.
Up to 10 pounds:
Up to 25 pounds:
Up to 50 pounds:
Up to 100 pounds:
More than 100 pounds:
This job has vision requirements as follows:
- Yes/No -
Clear close vision:
Clear distance vision:
Three-dimensional vision; ability to judge
distances and spatial relationships:
Ability to adjust eye to bring an object into
Specific demands not listed:
Job requires exposure to the following environmental conditions:
Wet, humid conditions (non-weather):
Work near moving mechanical parts:
Fumes or airborne particles:
Toxic or caustic chemicals:
Outdoor weather conditions:
Extreme cold (non-weather):
Extreme heat (non-weather):
Risk of electrical shock:
Work with explosives:
Risk of radiation:
Hearing ability required for work environment is:
- Yes/No -
Ability to hear alarms on equipment:
Ability to hear patient call:
Ability to hear instructions clearly:
The typical noise level for the work environment is:
Repetitive Motion Actions - Percent of Time -
Repetitive use of foot control:
Repetitive use of hands:
Grasping - simple/light:
Grasping - firm/heavy: