Patient Service Coordinator

The individual in this position provides assistance in coordinating all the functions and activities related to patient access in the department including, but not limited to, front end customer service, accurate patient registration in the approved organization electronic scheduling and billing systems, on-site insurance verification and financial counseling, accurate Time-of-Service (TOS) payment collections, and the balancing of all TOS payments using the approved organization electronic scheduling and billing system Front Desk Module. The person in this position ensures all scheduling, registration, and payment collection activities are staffed appropriately each day and supervises scheduling and front desk staff in conjunction with the Process Supervisor. Performs all master scheduling functions including development and maintenance of master schedules and daily scheduling edits. These functions are performed in accordance with Georgetown University Hospital's (GUH) philosophy, policies, procedures and standards.
Education

• Associate's degree AA degree required

Experience

• 3-4 years Experience in a customer service environment required
• Previous experience with an electronic health record system desired, especially GE centricity EHR or Aria. required
• Previous experience with computerized registration systems and supervisory experience preferred

Knowledge, Skills, and Abilities

• Excellent interpersonal communication and customer service skills, and good telephone etiquette.
• Knowledge of medical terminology.
• Effective oral and written communication skills.
• Ability to perform in a high pressure environment.
• Ability to organize and prioritize work.
• Ability to deal effectively and professionally with a variety of different individuals.

Registration Process - Coordinates the patient registration process, including staff adherence with all established policies and procedures related to querying the Enterprise Access Directory (EAD) and obtaining complete demographic and insurance information for each patient appointment.Assists with coordinating personnel activities, including interviews, orientation and training, scheduling, work sampling, quality assurance and performance management. Registers patients using the approved organization electronic scheduling and billing system patient scheduler system.Follows guidelines to avoid duplicate medical record assignment. Obtains and/or verifies complete demographic and insurance information from patient. Accurately enters complete demographics, insurance information and Financial Status Classification (FSC) / Hospital Patient Accounting Plan Code assignment.Scheduling Process - Coordinates the patient appointment scheduling process, including staff adherence with all established policies and procedures related to determining and accurately documenting the appropriate appointment type, provider, referral and/or authorization requirements, procedure orders, and other appointment specific requirements.Performs or insures the performance of daily scheduling edits as necessitated by provider schedule changes. Works closely with the Patient Services Supervisor and/or Department Administrator to ensure that the appointment scheduling office is appropriately staffed at all times. Schedules patient appointments using the approved organization electronic scheduling and billing system, entering all required data elements as dictated by the Georgetown Physicians Group (GPG), GUH and departmental policies and procedures. Identifies patient's insurance, ascertains GPG and GUH contract participation status (Par vs. Non-Par) and communicates contract participation status to patient.Coordinates the scheduling of surgical cases, procedures and admissions for the department, including staff adherence with GUH procedures and appropriate communication of GUH facilities, policies and instructions to patients and families. Coordinates the maintenance of the approved organization electronic scheduling and billing system patient scheduler system, including triaging referrals and/or orders to the appropriate physician for care. Performs or insures the performance of all master scheduling functions including development and maintenance of master schedules.Determines referral requirements, creates a Referral in the approved organization electronic scheduling and billing systems and links to appointment or updates Appointment Data Form (ADF) with Authorization / Pre-Certification number as appropriate. Answers incoming calls for practice and provides information regarding services, referrals, etc.Using standard forms or Electronic Health Record (EHR) system, records messages from patients, referring physicians, pharmacies, and other clinical areas. Communicates with physicians and nurses. Throughout the business day, ensures Automatic Call Distribution (ACD) system is functioning appropriately and reports any malfunctions immediately.Patient Arrival / Check-in & Check-out Processes - Coordinates the patient check-in and check-out process for department including patient reception, validation of patient identity, scanning of patient documents to the appropriate system, resolution of all alerts for missing or inaccurate information prior to patient arrival, insurance verification, collection and electronic posting of time of service (TOS) payments, appropriate and timely statusing of all appointments, collection and review of all encounter forms, daily deposit of TOS payments, and preparation of charge batches.Coordinates the daily batching process, including encounter form completion and reconciliation to optimize charge capture and reimbursement. Reports to the Patient Services Supervisor and/or Department Administrator on daily activity and process improvement initiatives.Recommends and implements corrective actions as appropriate. Checks patients in, completing all required steps including validating patient identity, scanning required documents, resolving all outstanding alerts, collecting TOS payments, and statusing appointments. Reconciles all monies collected, batches payments and delivers to designated department resource for creation of bank deposit. Prepares encounter form batches for submission to Physicians Unified Billing Service (PUBS).Referrals, Pre-certification and Authorization Process - Coordinates the referral, pre-certification and authorization process for department including staff adherence to all GPG, GUH and Managed Care Department requirements and contracts to ensure all patient appointments have required approvals in advance of the appointment. Determines in conjunction with the Process Supervisor and provider if an appointment can be rescheduled if there is a missing referral, pre-certification, or authorization. Coordinates communications with insurance companies, patients and providers regarding eligibility verification, benefits and deductible status, and authorizations for office-based and Hospital services, procedures and admissions.Ensures coordination with the Patient Financial Clearance Unit (PFCU) in obtaining any missing information for patient appointments. Ensures that eligibility and applicable authorizations are obtained prior to services being rendered for any and all accounts not previously verified through the PFCU.Coordinates documentation of referrals and authorizations in the approved organization electronic scheduling and billing systems, including staff adherence to correct use of all applicable data fields in the Open Referral Module and on the ADF.Participates in the training and education of staff on managed care contracts and processes, system utilization of the approved organization electronic scheduling and billing system, Joint Commission (JC) standards, and Health Insurance Portability and Accountability Act (HIPAA) privacy guidelines and compliance issues. Verifies eligibility and conformance to GPG, GUH and departmental managed care requirements and contracts.Obtains insurance referrals and pre-authorizations, as needed. Assists with pre-authorizations of hospital admissions, procedures, medications and medical equipment. Educates and informs patients and families regarding verification status and issues related to deductibles, co-payments and balances. Responds to hospital staff and/or patient inquiries regarding referrals, authorizations and scheduling in an efficient manner.Patient Health Records - Adhering to GPG, GUH and departmental policies and procedures, will access patient Medical Records / Electronic Health Records (MR/EHR), for work related activities only, to complete proper patient documentation in the health record or to view needed information in the patient chart as necessitated by job role or function.Adheres to most current work flows or processes developed within GPG or department. Assists in the supervision of the Scheduler, Front Desk, Administrative Support and Department Pre-certification / Authorization staff utilization of MR / EHR, ensuring protocols are followed. Monitors staff phone notes, prescription requests, and other EHR updates for timeliness and appropriateness.Patient Satisfaction - Works with Patient Services Supervisor / Department Administrator to resolve physician and/or patient concerns related to front desk, registration, and scheduling or authorization operations. Provides resolution for patient services concerns whenever possible. Communicates areas of concern to the Process Supervisor / Department Administrator. Responds to patient complaints and facilitates resolution of service breakdowns. Monitors patient satisfaction results, reviews with staff, and collaborates in process improvements.Performs other duties and responsibilities that are appropriate to the position and area. The above responsibilities are a general description of the level and nature of the work assigned to this classification and are not to be considered as all inclusive.

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