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Revenue Cycle PreArrival Services Coord

3 months ago

Rapid City, United States Monument Health Full time

Current Employees:

If you are a current employee, please apply via the internal career site by logging into your Workday Account and clicking the "Career" icon on your homepage.

Primary Location
Rapid City, SD USA

Department
RCH Revenue Cycle Management Services

Scheduled Weekly Hours
40

Starting Pay Rate Range
$23.95 - $29.94
(Determined by the knowledge, skills, and experience of the applicant.)

Job Summary
Under the general oversight of the VP of Revenue Cycle, the Revenue Cycle PreArrival Services Coordinator executes advanced-level functions to ensure optimal reimbursement for high-cost and high-risk requests for healthcare services. Utilizing their expertise, the PreArrival Services Coordinator reviews payer medical policies, assesses the medical necessity criterion, and employs critical thinking to ascertain if the criteria are met to facilitate the scheduling of financially cleared services and provides an escalated level of referral management and processing to ensure the proper interpretation, recording, adjudication, approval, and payment of requests for healthcare services. The PreArrival Services Coordinator must proficiently guide and support all staff, providers, and/or patients on available options and effectively address barriers to obtaining prior authorizations, complete financial clearance, or timely scheduling of services that will ensure resolution and closure to referrals or case requests. This role is crucial for securing reimbursements, reducing organizational financial risk, and optimizing schedule utilization to safeguard timely patient access to care.
The Revenue Cycle PreArrival Services Coordinator must consistently demonstrate skilled communication and troubleshooting techniques as well as excellent customer service skills. They must be able to de-escalate concerns and anxiety at the patient and provider level and must have the ability to anticipate and respond to a wide variety of issues/concerns to execute tasks efficiently and effectively. The position requires the ability to independently plan, schedule and organize numerous tasks. The PreArrival Services Coordinator must be able to work under high pressure and very tight timelines so as not to negatively impact patient care.

Monument Health offers competitive wages and benefits on qualifying positions. Some of those benefits can include:

*Supportive work culture

*Medical, Vision and Dental Coverage

*Retirement Plans, Health Savings Account, and Flexible Spending Account

*Instant pay is available for qualifying positions

*Paid Time Off Accrual Bank

*Opportunities for growth and advancement

*Tuition assistance/reimbursement

*Excellent pay differentials on qualifying positions (extra pay for working evening, nights or weekends)

*Flexible scheduling

Job Description

Essential Functions:

  • Coordinate the scheduling and authorization of referral for services requests that enhance timely patient access to care and uphold organizational values while serving as a key resource for providers, departments, clinical staff, operational staff, Finance, Revenue Cycle, and patients.
  • Conduct advanced critical analysis to ensure optimal reimbursement, focusing on mitigating risks associated with high-cost services, surgical care, and services prone to payer denial.
  • Adhere to complex scheduling guidelines, accurately interpret orders and treatment plans, and coordinate appointments requiring multiple resources, including but not limited to, surgical, non-surgical procedures, diagnostic, and imaging services.
  • Independently manage appointment schedule requests, assign resources, revise schedules as needed, and ensure accuracy by collaborating with providers, clinical staff, and operational staff, promptly communicating changes to relevant personnel.
  • Effectively Interact with medical and professional staff to secure necessary clinical information for prior authorizations, initiating activities to gather missing data (e.g. coverage information, procedure, and diagnosis codes) to ensure timely submissions for prompt payer resolution.
  • Review and evaluate referrals for service and appointment to ensure the appropriateness and medical necessity based on payer medical policies and established criteria. Utilize background and experience to translate payer medical policies and assist with determining if requests will meet the necessary payer criteria. Apply appropriate criteria to scheduled admissions and outpatient procedures for all payers and programs, including Medicare, Medicaid, VA, Tricare, IHS, and varied commercial payers.
  • Prioritize the urgency of authorizations by anticipating the time required to obtain authorization from insurance companies, considering the complexity of the procedure and the scheduled date of service. Follow up with payers or programs when requested to expedite urgent or emergent authorizations.
  • Support the peer-to-peer and appeal processes from a clinical perspective when payment is denied by the payer. Identify accounts lacking authorizations and collaborate with providers or clinical teams to determine the urgency of scheduled services, advising on whether they can be delayed or need to proceed.
  • Appropriately use organizationally approved communication pathways such as Epic, Secure Chat, In Basket Messaging, and telephone to securely gather and share patient information, supporting scheduling, prior authorization, and financial clearance processes and facilitating effective information exchange within the organization.
  • Understand patient status delineations (outpatient, inpatient, observation) per payer regulations, actively engage in interdepartmental discussions, and educate providers on complex cases and service episodes needing additional attention.
  • Conduct financial clearance reviews, educate patients/providers on payer complexities/policy changes, adapt prior authorization practices accordingly, and execute insurance eligibility checks across various payers (Medicare, Medicaid, VA, Tricare/UHC, commercial).
  • Communicate financial responsibilities to patients regarding service authorization, offer pre-payment options, manage expectations to alleviate concerns, collect pre-payments, establish financial agreements as needed, and assist with financial clearance paperwork to maximize reimbursement and promote patient financial wellness.
  • Adhere to quality assurance, operational standards, and productivity expectations, demonstrating initiative, proficiency, strong decision-making, organizational skills, and a commitment to quality service. Ensure accuracy and thoroughness in all patient-related activities, including electronic communications.
  • Navigate multiple systems independently, respond to inquiries autonomously, demonstrate strong attention to detail, follow-through, and effective prioritization with minimal oversight. Maintain confidentiality in handling results, patient information, and business interactions.
  • Demonstrate proficiency, experience, business acumen, and best practice awareness of the healthcare industry, healthcare insurance, and medical terminology.
  • All other duties as assigned.


Additional Requirements

Required:

Education - High School Diploma/GED Equivalent

Experience - 5+ years healthcare experience in revenue cycle, financial services, business office, coding, or related support services role

Preferred:

Education - Bachelor's degree in Healthcare Administration, Business, or medical related field

Experience - 7+ years healthcare experience in revenue cycle, financial services, business office, coding, or related support services role

Physical Requirements:
Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.

Job Category

Job Family
Revenue Cycle

Shift

Employee Type
Regular

10 Monument Health Rapid City Hospital, Inc.

Make a difference. Every day.

Monument Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.