Scheduling and Prior Authorization Representative presso McKenzie Health

Description

Scheduling and Prior Authorization Representative

POSITION DESCRIPTION:

The Scheduling and Prior Authorization Representative supports the integrated scheduling department by scheduling surgeries, procedures, exams, infusions, therapies and evaluations for inpatient, outpatient, and clinic departments, modalities and facilities. Performs pre-registration, registration, and insurance verification functions and obtains prior treatment authorizations as needed. Provides excellent patient focused customer service. Communicates effectively to service delivery areas to maximize patient flow and customer service. Communicates insurance updates and billing information as identified to department leadership. Maintains quality assurance standards and seeks education opportunities to support role.

Supervisory Responsibilities:

• None

Duties/Responsibilities:

• Scheduling
• Pre-registration
• Registration
• Insurance verification
• Pre-encounter collections
• Prior authorization
• Serves as central point of communication for community referring physicians and offices, system patient services, and caregivers to secure resources necessary for patient care.
• Interfaces and/or works directly with nursing units, technologists, physicians, community offices and other medical facilities to coordinate cases and appointments.
• Receives incoming phone calls related to all aspects of scheduling and coordination of patients and resources.
• Assures all changes to schedules are in accordance with policies and alerts appropriate leadership when out of compliance. Promotes adherence to scheduling practices.
• Collects and evaluates patient demographic, insurance, clinical and non-clinical information.
• Identifies inaccuracies and missing data that would affect departments’ financial results; monitors cancellation and rescheduling of cases and appointments to manage schedules; identifies potential resource conflicts and works with leadership to resolve.
• Ensures cases and appointments have prior authorization; may coordinate with Financial Counseling to inform patient of financial responsibility.
• As a condition of employment, completes all assigned training and skills competency.
• Other duties as assigned.

Nothing in this job description restricts MH ability to assign, reassign or eliminate duties and responsibilities of this job at any time. MH does not restrict the tasks that may be assigned. Critical features of this job have been described; those features may be changed at any time due to reasonable accommodation or other reasons deemed appropriate by MH.

Qualifications

Physical Requirements:

• Physically demanding, high-stress environment
• Sitting for extensive periods of time
• Ability to lift, move, push or pull a minimum of 15 pounds.

Required Skills/Abilities:

• Knowledge of hospital and physician access management processes.
• Clear, effective communication skills
• Must be a supportive team member, contribute to and be an example of teamwork.
• Ability to deal tactfully with providers, personnel, residents, family members, visitors, government agencies and the public.
• Excellent customer service skills.
• Able to communicate effectively in English, both verbally and in writing.
• Basic computer skills, including ability to navigate electronic medical record systems.
• Knowledge of medical terminology
• Detail oriented
• May work beyond normal working hours and on weekends holidays when necessary.
• Must be able to pass a background check and drug screening.

Education/Experience:

• High school diploma or equivalent required.
• College degree preferred.
• One to three (1-3) years’ experience in healthcare scheduling, authorization, customer service or financial counseling.
• Knowledge of medical terminology
• Basic computer knowledge, data entry and/or word processing.

Licenses/Certifications:

• None

NON-DESCRIMINATION STATEMENT

It is the policy of McKenzie Health not to discriminate against any applicant for employment, or any employee because of age, color, sex, disability, national origin, race, religion, or veteran status.