JOB DESCRIPTION
JOB TITLE: REHABILITATION SERVICES SPECIALIST
MAIN FUNCTION:
Works within a team environment to obtain prior authorization, complete patient registration, and schedule initial evaluations for physical, occupational and speech therapists for all outpatient rehabilitation locations across the system. Must have education in anatomy and ICD-10 coding to ensure proper reimbursement. This position must be cross-trained in the positions of Rehab Secretary and Outpatient Rehab Technician at all six outpatient rehab locations to aid in providing initial orientation and training for those positions, as well as to provide clerical or clinical coverage as needed. Reports directly to the System Director of Rehab Services.
DUTIES AND RESPONSIBILITIES:
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Promptly answers the telephone in a professional and courteous manner. Returns phone messages within 24 hours. Demonstrates the knowledge and ability to utilize various telephone applications including, but not limited to, forwarding and establishing conference calls.
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Demonstrates the knowledge and ability to work with a variety of applications for authorization, registration, scheduling, clinical documentation and communication, including, but not limited to, ReDoc, insurance websites, eClinicalWorks, Soarian, Quadramed and Qliq.
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Demonstrates an understanding of general anatomy, medical terminology and ICD-10 coding specific to rehab billing to ensure that referring physicians are providing appropriate codes that will allow maximum reimbursement for treatments.
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Demonstrates insurance knowledge for the purpose of fulfilling preauthorization requirements. Obtains prior authorization for services as required in a timely manner utilizing any potential sources for relaying accurate information (i.e. phone, fax, e-mail, website).
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Demonstrates the ability to accurately register patients in Soarian. Registers patients in a timely manner.
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Promptly retrieves referrals from physician offices via phone call, fax, e-mail and eClinical Works, or follows up with offices to request referral when patients call to schedule their own appointments.
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Demonstrates the knowledge and ability to schedule simple and complex patient
appointments for all outpatient locations across our three-hospital system, and in coordination
with specific therapist specialties and/or certifications. Completes scheduling in a timely
manner.
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Accurately follows all insurance guidelines when scheduling initial appointments, with special consideration for Fidelis/Medicaid, Blue Cross, Worker's Comp, Empire and self-pay, to ensure authorization is obtained and decrease risk for denials.
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Coordinates patient information with the treating facility including authorization approval, insurance information, co-pay amount, visits approved, etc. to ensure communication is included in the patient's chart and available for reference as needed.
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Demonstrates knowledge of the method of proper sequencing of initial evaluations (i.e. prioritization based upon date of referral, diagnosis, and specific requests for therapists and /or locations) to ensure the smooth daily operation of the department and to best manage access to care.
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Demonstrates knowledge of the required patient preparation for all evaluations and communicates this information at the time of scheduling (i.e. arriving early, wearing comfortable clothing, bringing insurance cards, co-pay amount, directions, screening questions if applicable).
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Demonstrates the ability to communicate courteously and effectively with internal and external customers. Utilizes Qliq as appropriate to communicate with physician and rehabilitation offices. Ensures appropriate follow-up with referral sources when patients frequently cancel or no show for initial appointments.
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Demonstrates the ability to be cross-trained to other responsibilities of the department as required by the director/supervisor, however, the primary responsibility is patient authorization, registration and scheduling.
OTHER:
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Has general knowledge of the Medical Center's departments and how these departments interact with each other.
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Has the ability to conference with other departments and/or rehab locations to bring about conflict resolution to scheduling problems.
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Demonstrates reliability in the conscientious, complete and accurate manner in which work assignments are performed.
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Demonstrates the ability to perform multiple tasks as required by the position.
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Continuously utilizes time to maximize full potential, sets priorities and uses good organizational skills.
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Maintains professional behavior and appearance at all times. Is accountable for own actions.
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Possesses the highest ethical standards with respect to discretion and regard for
confidential information.
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Attends staff meetings and completes all mandatory educational programs as required by position.
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Demonstrates Quality Improvement principles in daily work and participates in QI monitoring and reporting (including tracking referrals scheduled and access to care).
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Maintains complete understanding of the Medical Center's emergency codes. Understands role in emergency situations.
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In order to provide the highest quality care to our patients and/or facilitate improved access to care, individuals may be required to work hours beyond those normally scheduled or different than normally scheduled. Work schedules may be subject to change based upon the needs of the
department.
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Employee understands and demonstrates the importance of satisfying the needs of the customer/patient by interacting with him/her in a friendly and caring way, being attentive to the customer's needs, both psychologically and physically, and by taking the initiative to maintain communication with the customer in order to provide a secure and pleasant experience within Arnot Health.
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It is understood that this job description lists typical duties for the classification and is not to be considered inclusive of all duties which may be assigned.
EDUCATION:
High school diploma or equivalent. Hospital experience or rehabilitation services background required. Knowledge of anatomy and medical terminology required. Knowledge of ICD-10 coding strongly desired. Must have solid proficiency in all Microsoft Office applications.
EXPERIENCE:
One to two years of experience in a health care setting. Must be knowledgeable regarding both clerical and clinical aspects of rehabilitation services. Must possess strong organizational skills that reflect the ability to perform and prioritize multiple tasks with excellent attention to detail. Must take a proactive approach to problem-solving and have strong decision making capability. Must be a highly resourceful team player with the capability to also be extremely effective independently.
CARDIOPULMONARY RESUSCITATION (CPR) REQUIREMENTS:
Basic Life Support (BLS) required within 90 days of hire date.
PHYSICAL DEMANDS:
Due to the possibility of assisting at any rehab location with patient-related care: Appreciable physical effort or strain; occasionally repetitive efforts may involve lifting, pushing, and pulling. Must be able to lift at least thirty (30) pounds independently and at least one-hundred fifty (150) pounds with assistance of another person.
EXPOSURE CATEGORY:
Category III. Tasks that involve no exposure to blood, body fluids, or tissues, but employment may require performing unplanned Category I tasks.
