Major Responsibilities:
Using AIDET, collects, analyzes and records accurate and compliant demographic and clinical information in the scheduling system. Meets or exceeds productivity standards.
Using approved identification standards, positively identifies the patient before accessing existing medical record numbers or creating new patient entries.
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Provides patients with site and appointment date and time options, scheduling per patient preference or first appointment at optimal site.
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Accurately enters all required patient demographic and clinical data in scheduling application.
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Checks receipt of faxed orders and reviews for accuracy. Documents record if new or revised written orders are needed on day of service.
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Schedules with proper test sequencing when multiple tests are ordered, ensures there are no clinical, equipment or physician conflicts.
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Engages in frequent communication with all departments to ensure scheduling openings are current and time blocks are administered as needed.
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Explains procedures and provides patients/customers with accurate preparation information prior to exam. Ensures understanding of pre-procedure clinical requirements.
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Provides directions for patients to follow on day of service and ensures understanding of where to park, where to check-in, when to arrive, etc.
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Maintains synchronicity between the scheduling and registration systems when rescheduling, canceling or editing accounts.
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Identifies and respond appropriately to callers' communication needs, secures interpreter to complete scheduling and documents record for future visit.
Accurately collects, records and analyzes all required demographic, insurance/financial and clinical data necessary to preregister/preadmit patients from all payer classes. Meets standards for productivity defined as 100% scheduled patients pre-registered prior to arrival.
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Scans (or ensures) printed orders into the patient’s account or validates the patient is to bring on the day of service.
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Completes the MSP (Medicare Secondary Payer Questionnaire) thoroughly. Uses appropriate insurance codes accounts when Medicare is deemed secondary to other insurance.
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Preforms an abbreviated screening of insurance benefits and attempts to fast pass pre-registered accounts when able.
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Records accounts notes and appropriately codes accounts for hand-off to financial clearance.
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Reviews physician orders and other documentation against Medicare payer coverage and medical necessity criteria; translates text into code and uses screening software to determine whether services being provided meet third-party requirements for payments. Sends electronic requests to physicians to obtain additional diagnoses on orders as needed.
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Identifies if authorization/prior approvals are required for scheduled services. Requests and documents as appropriate.
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Schedules patients without authorization at least three days out to allow sufficient time to financially clear account. Escalates accounts to appropriate persons if time frame is shortened and account needs higher priority.
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Pre-authorizes patient for services with insurance company.
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Collects and records accurate and thorough patient, guarantor, insured and insurance information when preregistering patient accounts.
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Pre-registers accounts using appropriate clinic and service codes; and establishes account parameters to ensure revenue is properly recorded and accurate bills are produced.
Performs revenue cycle activities that prevent payment denials, increase cash collections and assures appropriate financial disposition of account balances. Meets defined standards for quality. i.e., all components of the pre-reg process must be completed pre-service, including discussions with patients when necessary. Accounts should require minimal registrar intervention on the actual date of service.
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Verifies insurance eligibility, reviews and if applicable, notifies the patient’s primary, secondary and tertiary insurance companies of the scheduled service and obtains benefit information and service authorizations.
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Follows up any accident, injury, or third party liability diagnosis appropriately and documents coverage determinations.
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Reviews the pass/fail of Medicare patients’ outpatient testing per passed medical necessity guidelines and follows up with physician as necessary to request additional (if applicable) orders/diagnosis prior to a patient's service date
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Identifies payment obstacles for Medicaid patients and takes appropriate action including following up on billing codes and other State specific program requirement
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Communicates with appropriate persons regarding all aspects of pre-registration, registration, verification, precertification and date of service / insurance issues
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Alerts Financial Counselors when presented with out of network plans, insurance denials, and high dollar deductible and out of pocket maximums
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Enters thorough account notes in system and documents accounts with applicable financial clearance information
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Enters verification flag in system as applicable
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Contacts the patient/representative, physician, insurance company or others if additional information is needed to financially clear patients on the date of service.
Places reminder calls to pre-registered patients 24-48 hours prior to service date and ensures each accounts' financial clearance disposition is correct and easily identified for the date of service registrar.
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Reviews reports to determine who needs reminder calls.
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Refers to coordinator/manager any accounts that do not meet standards for financial clearence disposition.
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Confirms service date/time/place with patients and reschedule services as needed.
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Informs callers of insurance company findings (i.e. deductible, co-insurance and co-payment), collects pre-visit deposits or secures payment promises.
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Provides patients with information about their arrival and service area needs. i.e., what time to arrive, where to park, where to go, what to bring with them. etc.
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Review accounts for completeness and accuracy and updates account documentation/finanical cleareance disposition as needed.
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Indexes and names faxes located in fax storage system.
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Accepts and completes other duties and special projects as assigned.
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Performs other duties as assigned.
Education/Experience Required:
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HS diploma or equivalent.
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2-3 years related experience, preferably in a healthcare setting (revenue cycle experience preferred), hospital, physician office or insurance company.
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Applicable education may be substituted.
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Basic knowledge of medical terminology.
Knowledge, Skills & Abilities Required:
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Effective organizational and prioritization skills
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Exhibits sophisticated interviewing, communication and negotiation skills.
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Possesses intermediate math and business writing skills
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Knowledge of office equipment Computer literate
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Demonstrated customer service skills.
Physical Requirements and Working Conditions:
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Ability to work in a fast-paced environment with established time constraints and emotional and sensitive situations.
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Employee is regularly required to sit, stand, walk, talk and hear.
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Must possess visual acuity and manual dexterity to perform computer data entry and other clerical aspects of the job.
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May bend, stoop, twist and reach in conjunction with the job requirements.
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May lift files, reference books, supplies, and other documents up to 10 lbs.
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May walk and push a wheeled cart with a computer and supplies weighing up to 50 lbs.
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This is both a sedentary and active position. Employee is regularly exposed to noise associated with working around others in an office setting.
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May be exposed to a variety of illness and medical conditions.
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Must be able and willing to work weekends, holidays and occasionally other shifts.
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Must be able and willing to rotate work environments. May need to work shifts at off-site locations.
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If position has direct patient care or direct patient contact the following lifting requirement supersedes any previous lifting requirement effective 06/01/2015.
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Ability to lift up to 35 pounds without assistance. For patient lifts of over 35 pounds, or when patient is unable to assist with the lift, patient handling equipment is expected to be used, with at least one other associate, when available. Unique patient lifting/movement situations will be assessed on a case-by-case basis.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
