Pre Service Scheduler

Pre Service Scheduler

Requirements

• Typically requires 1 year of experience in health care, insurance industry, call center or customer service setting.
• Demonstrated ability to identify and understand issues and problems. Examines data and draws logical conclusions based on information available.
• Knowledge and ability to articulate explanations of Medicare/HIPAA/EMTALA rules and regulations and comply with updates on insurance pre-certification requirements.
• Mathematical aptitude, effective communication skills and critical thinking skills.
• Understanding of basic human anatomy, medical terminology and procedures for application in the patient referral/pre-certification/authorization processes.
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.
• Ability to speak effectively to customers or employees of organization, maintaining a pleasant, professional demeanor.
• Ability to handle sensitive and confidential information according to internal policies.
• Ability to problem solve in a high profile and high stress area, working independently to set and meet deadlines and prioritize work.
• Demonstrated technical proficiency including experience with insurance verification/eligibility tools, EPIC electronic medical record, patient liability estimation tools, Microsoft Office, Internet Explorer and phone technology.

Responsibilities

• Contacts the patient to obtain/validate demographics and insurance information. Completes insurance verification and eligibility checks and documents patient liability.
• Collects and accurately documents initial pre-certification/authorization information if available. Initiates the process for obtaining a required referral/authorization if not obtained.
• Calculates patient liabilities based on scheduled procedures and previous balances. Informs the patient of his/her liability and discusses financial obligations with the patient including requesting payment.
• Communicates to physician office/patient the organization expectation of payment and/or having an authorization on file prior to service, explaining service may be re-scheduled.
• Schedule patient visits using guidelines established within scheduling system. Recognizes exceptional scheduling situations and escalates as necessary. Completes necessary online EPIC questionnaires needed to complete scheduled exam.
• Provides accurate, detailed information regarding test preparations, time of patient arrival and any other directional information.
• Works assigned EPIC Scheduled Order Work Queue, following the department’s work flow process on appropriately transferring, deferring or removing orders from the work queue.
• Proactively communicates issues involving customer service and process improvement opportunities to management.
• Maintains excellent public relations with patients, families and clinical staff as well as demonstrates a willingness and ability to work collaboratively with others for concise and timely flow of information.
• Maintains knowledge of and reference materials for Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization/referral and a list of current accepted insurance plans.

Preferred Qualifications

No preferred qualifications provided.