Surgery Coordinator, Ent Institute
3 weeks ago
This position will determine insurance eligibility, financial status and eligibility for registration by reviewing insurance information via phone or on line verification, calling third party payers to obtain insurance benefits which include the effective dates of coverage, billing address, pre-existing condition clauses, in and out of network benefits and maximum coverage. Such duties include but are not limited to: Meeting with the patient and explaining their surgery orders and pre-surgical testing needed, scheduling in-office and in-hospital procedures, making sure necessary authorizations have been obtained, data entry into the facility computer system and implementing/participating in the development of new diagnostic testing or programs.
POSITION EDUCATION/ QUALIFICATIONS:
- High School graduate or G.E.D. certificate preferred
- Completion of CNA program, Medical Office Specialist, or like program preferred
- Position requires travel, valid driver's license and vehicle insurance are required
- Two (2) years continuous experience in a busy healthcare office with at least one (1) year insurance verification experience (required), and 6 months-1 year worker's compensation experience is preferred; previous surgical scheduling experience is preferred.
- Prefer previous physician office or hospital experience
- Must have Excel, Microsoft suite computer experience and must be able to learn department IS system
- Must have excellent customer service skills
- Medical Terminology, ICD Codes, CPT Codes, HCPCS codes, and Modifier knowledge preferred
- Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly
- Requires reasoning ability and good independent judgment
- Requires working with frequent interruptions
- Must project a professional image
- Must be able to be sensitive to cultural and bilingual issues
- Excellent organizational skills are necessary
- Good written and verbal communication skills required
- Ability to read, write and speak English
- Good understanding of insurance benefits, surgical orders and medical terminology.
- Ability to communicate clearly and concisely with all levels of nursing, administration, patients and physicians
- Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
- Schedule Surgeries, for both in-hospital and in-office procedures
- Obtaining Authorization or pre-cert as needed for the above
- Schedule, coordinate and monitor appointments of patients for pre-surgical diagnostic testing and registration
- Forwards a completed copy of schedule with applicable patient benefits to front desk staff and/or MD for collection of applicable deductible and co-pay amounts
- Confirms billing address, pre-existing conditions, in and out of network benefits and maximum coverage
- Reviews and confirms patient's financial information by obtaining the insurance carrier information, benefit information, policy number, group name, group number, and the effective date of coverage
- Ability to reference ICD-9-CM/ ICD-10-CM, CPT from doctor's order to insurance carrier for eligibility and coverage of procedure
- Reviews and confirms patient's deductibles, co-pays, and co-insurance with insurance carrier
- Ability to identify the appropriate coordination of benefits for insurance carrier
- Utilizes phone or on-line verification systems, i.e. TMHP, Availity, Data Link, internal system, etc., for insurance eligibility and benefits
- Determines financial status, meets with patient and refers patient for financial screening as appropriate
- Ensures referral/pre-authorization/pre-certification requirements have been met
- Obtains date of injury, compensable bodily injury, adjuster's name, onset of illness and claim number, for worker's compensation claims, as needed
- Reviews physician order for appropriate patient status (Inpatient/Outpatient) before verifying coverage for procedure
- Document clearly and concisely all patient benefit information on accounts through the computer system
- Screen and follow up on patient test results as required
- Has appropriate follow up and contact with hospital or patient if necessary
- When working at the reception desk, checking patients both in and out of the practice properly documenting registration in the computer, as needed
- Ensures patient confidentiality requirements are met in accordance with HIPAA/PHI policies and procedures
- Understand and adhere to managed care policies and procedures
- Perform inventory of supplies and equipment as necessary
- Answer and direct all phone calls appropriately
- Effectively communicates and works well with other team members
- Adheres to assigned projects/tasks, and volunteers for special assignments/projects
- Scans information into the EMR as needed
Other duties as assigned.
AGE SPECIFIC:
Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirement relative to his or her age.
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