Authorization/Scheduling Coordinator

The Hospital Authority of Miller County•Colquitt, GA

About The Position

The Patient Access Authorization Scheduler Coordinator completes accurate pre-registration, registration, and scheduling for hospital patients. The role verifies and documents insurance coverage, obtains pre-certifications and authorizations, verifies pre-authorization for exams, answers questions, explains policies, advises patients about scheduled procedures and estimated patient responsibility, and performs other related duties. The coordinator schedules therapy and other procedures, coordinates with physician offices and hospital departments, obtains required patient information and signatures, and helps patients understand their insurance coverage and the authorization process. The role also collects and balances patient payments, maintains accurate records, supports excellent patient and family experiences, protects confidentiality, and meets established quality and productivity standards. The schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m.; additional scheduling needs, including overtime, may occur.

Requirements

High school graduate or equivalent.
At least three years of relevant experience in a healthcare setting.
Previous appointment-scheduling experience in a healthcare environment, such as a physician office, clinic, or hospital.
Strong understanding of medical terminology, ICD-10, and CPT coding.
Ability to communicate in English verbally and in writing.
Strong written and verbal communication skills.
Excellent communication, interpersonal, and customer service skills.
Ability to communicate authorization status and requirements with patients, physicians, clinical staff, and insurance representatives.
Accurate data-entry skills and strong attention to detail.
Strong organizational skills.
Proficiency with computer systems and software, including electronic health records and payer portals.
Proficiency with Microsoft Outlook, Word, and Excel, and ability to navigate internet websites and systems such as Availity, MyAbility, Relias, and Cerner.
Ability to follow up on pending authorizations and proactively address issues or denials.
Ability to maintain operational knowledge of insurance requirements necessary to achieve optimal reimbursement.
Ability to perform the listed registration and authorization duties and maintain the required competency.
Ability to comply with organizational policies, ethical business practices, regulatory requirements, patient confidentiality, and the Code of Conduct.
Ability to wear protective clothing and equipment as appropriate.
Ability to work through changing tasks, periods of high stress, and fluctuating workloads while maintaining efficiency and composure.

Nice To Haves

Experience in medical billing, insurance verification, pre-authorization, and scheduling.
Familiarity with insurance plans, including HMOs, PPOs, and government programs.
Certified Patient Account Representative (CPAR) certification.
Certified Revenue Cycle Representative (CRCR) certification.
Working knowledge of governmental regulations and other reimbursement criteria.
Experience in patient registration, verification, and authorization in a medical center or comparable institution.
Additional language skills.

Responsibilities

Complete accurate pre-registration, registration, and scheduling for hospital patients.
Schedule therapy procedures and other procedures as necessary.
Answer telephone calls professionally, direct calls appropriately, and manage internal calls as requested.
Contact designated personnel about scheduling changes, including cancellations, additions, and time changes.
Pre-register at least 98% of scheduled patients a minimum of three business days before arrival.
Obtain, validate, and accurately enter patient demographic and insurance information into the computer system.
Obtain information from physician offices or patients through direct contact, telephone, or fax.
Identify complex authorization issues and escalate them to senior team members.
Obtain signatures on forms and documents required by the hospital or law.
Ensure the Medicare Secondary Payer (MSP) Questionnaire is completed for every Medicare registration.
Coordinate with physician office staff, schedulers, and hospital departments to prepare information before patient arrival.
Use online programs to verify insurance eligibility and benefits, and document findings in patient accounts.
Contact insurance companies for required pre-authorizations and pre-certifications before services are provided.
Collect applicable co-payments, deductibles, and co-insurance when patients arrive for service.
Log cash collections, issue receipts, maintain a balanced cash drawer, and meet monthly cash collection goals.
Provide professional customer service and communication to internal and external contacts, patients, and their families.
Meet established quality and productivity standards for self and the team, and track productivity as requested.
Keep the Department Director, including Radiology, informed of authorization delays.
Stay current on scheduling, registration, insurance verification, and other patient registration processes to provide coverage for absent team members.
Maintain patient confidentiality and comply with HIPAA guidelines.
Maintain annual competency and complete required training, in-services, meetings, and evaluations on time.
Follow time and attendance standards and provide required notification of absences or tardiness.
Adapt positively to changes in hospital policies, procedures, operations, and insurance requirements.
Inform the supervisor or manager of problematic situations and support recommendations or decisions.
Perform other duties as assigned.