Patient Financial Specialist III

Trinity Health•Columbus, OH

2d•Onsite

About The Position

The Patient Financial Specialist III performs all the functions of a PFS II. In addition, the PFS III performs verification of prior authorization and obtaining precertification for selected scheduled services. Also, this staff member is proficient in scheduling complex procedures from the physician’s office as well as complex and changing insurance/reimbursement requirements.

Requirements

High School Diploma
Working knowledge of medical terminology, and data entry skills.
Past work experience of at least two (4) years within a physician office, hospital or clinic environment, performing patient scheduling and precertification activities is highly desired
Proven experience in 2 of the 4 following areas: Web and fax orders, Outpatient IV scheduling, Complex physician office scheduling such as Wound care and physician performed procedures, or Precertification.
Excellent interpersonal skills are necessary in dealing with peers, internal, and external customers.
Accuracy, attentiveness to detail and time management skills are required.

Responsibilities

Performs activities that relate to patient scheduling, pre-registration, real-time eligibility verification, medical order processing, medical necessity review (LMRP/LCD review), dissemination of patient information, and support coverage of other intra-departmental functions.
Determines proper scheduling requirements and/or limitations according to requested test(s)/procedure(s) and schedules resources (equipment, staff, room, and etc.) in a timely manner to ensure customer satisfaction, maintain patient flow, and appropriate utilization of the service area.
Coordinates add-on and same-day appointments with the service area, as required.
Ensures proper test sequencing with minimal patient delays when multiple testing is required.
Provides patient, family and physician office education during scheduling process to inform them of preparations needed for diagnostic testing and proper scheduling instructions.
Communicates with various ancillary departments to ensure an accurate schedule and that all reports are properly distributed.
Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance.
Contacts physicians/office staff for clarification, if cases require clarification of diagnosis and/or test(s)/procedure(s).