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Lead Patient Svs Coord GPG
4 months ago
EducationAssociate's degree Required Experience3-4 years Experience in a customer service environment Required and Medical/clinical office experience Preferred and Previous experience with computerized registration systems and supervisory experience strongly preferred. Working knowledge of IDX / GE centricity business preferred. Previous experience with an electronic health record system desired, especially GE Centricity EHR or Aria Preferred Licenses and Certifications No special certification, registration or licensure Required Knowledge, Skills, and AbilitiesExcellent 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.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. Registers patients using the approved organization electronic scheduling and billing system patient scheduler system. Follows guidelines to avoid duplicate medical record assignments. Obtains and/or verifies complete demographic and insurance information from patients. Accurately enters complete demographics, insurance information, and Financial Status Classification (FSC)/Hospital Patient Accounting Plan Code assignment.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. 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.Schedules patient appointments using the approved organization's 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. Determines referral requirements, creates a Referral in the approved organization's electronic scheduling and billing systems, and links to an appointment or updates Appointment Data Form (ADF) with Authorization/Pre-Certification number as appropriate.Coordinates the maintenance of the approved organization's electronic scheduling and billing system patient scheduler system, including triaging referrals and/or orders to the appropriate physician for care. Performs or ensures the performance of all master scheduling functions including the development and maintenance of master schedules. Performs or insures the performance of daily scheduling edits as necessitated by provider schedule changes.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.Coordinates the patient check-in and check-out process for the 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. Ensures compliance with all applicable Georgetown Physicians Group (GPG), GUH, department and internal audit policies and procedures.In conjunction with the Patient Services Supervisor and/or Department Administrator, ensures accurate review, follow up and completion of the approved organization electronic scheduling and billing system standard and custom reports, including past pending, missing charge, charge lag and rejection reports. 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).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.Adhering to GPG, GUH and departmental policies and procedures, accesses 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 workflows or processes developed within GPG or department.Assists with coordinating personnel activities, including interviews, orientation and training, scheduling, work sampling, quality assurance, and performance management. Works closely with the Patient Services Supervisor and/or Department Administrator to ensure that the appointment scheduling office is appropriately staffed at all times. 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.Works with Patient Services Supervisor/Department Administrator to resolve physician and/or patient concerns related to the front desk, registration, and scheduling or authorization operations. Provides resolution for patient services concerns whenever possible. Communicate 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.Monitors clinical facility needs and space to ensure a clean, safe environment for patients. Ensures personal workspace is neat, clean, and free of debris at all times. Orders required supplies, including encounter forms, HIPAA booklets, Patient Rights and Responsibilities sheets, and office supplies. Maintains and utilizes all office equipment such as computers, fax machines, telephones, etc. according to manufacturer's recommendations. Maintains competency in all electronic systems required for job functions. Reports computer malfunctions, software issues and/or problems to the Help Desk or appropriate staff.Observes Joint Commission (JC) standards, Patient Safety initiatives, Patient Rights, and HIPAA Privacy standards. Follows care, documentation, and cleanliness standards in the performance of job duties. Completes in-services and education on a timely basis. Is focused on patient safety during performance of duties and improves or makes corrections when safety issues arise; notifies department manager, as required. Interacts with other team members both on the unit and in other units in an appropriate and proactive way to benefit the patient.Observes proper elevator etiquette and courtesy: smile and speak to patients and visitors, does not discuss patient care and keep your voice low, give right-of-way to patients and visitors. Keeps all patient information strictly confidential. Never discusses patient information and hospital business in public areas. Protects patient privacy in public areas. Adheres to all JC and GUH Patient Rights standards.Actively participates in departmental and hospital meetings, such as Clinical Practice, Managed Care, Compliance, etc. Represents the department at GUH & GPG User Meetings. Relays relevant information to front-desk staff provides training and documents as appropriate
