Prior Authorization/Centralized Scheduler, ONSITE

Amberwell Health•Atchison, KS

8d•Onsite

About The Position

Prior authorization and centralized scheduler are key members of the team. The scheduler will work under the direction of the Director of Patient Access. The prior authorization/centralized scheduler position will be responsible for scheduling patients, obtaining prior authorization, creating the estimate of services, and having financial conversations with patients and/or guardians. These tasks are completed by assisting the patient, parent/guardian, or providers office with a friendly, courteous manner and high level of professionalism. Schedulers ensure the accuracy and integrity of patient information and test orders, while maintaining a high level of confidentiality. Duties may include but are not limited to: Able to work independently and as a member of a team. Understand and follow safe work practices. Ensure that all Amberwell procedures are followed in accordance with established policies. Demonstrates a knowledge of cultural diversity, the ability to provide care and service and exhibit the communication skills necessary to interact effectively with the patient/family/customer. Proactively serves as a patient advocate by always utilizing courteous and professional etiquette by answering the telephone promptly, reflecting a positive tone and speaking distinctly with poise, tact, and assurance. Coordinate with physicians, nurses, staff, patients, and other medical departments while setting up appointments, making sure prior authorization has been checked and/or received and orders are obtained prior to or immediately following the scheduling process. Validates the prior authorization CPT codes match the actual test that has been ordered, troubleshooting any discrepancies prior to placing the patient on the schedule. Responsible for ensuring the accuracy and integrity of patient information and test orders, attaching orders, while maintaining a high level of confidentiality. Verify medical necessity on all applicable patients scheduled by obtaining the diagnoses related to the procedure(s). Assign diagnosis code(s) for each diagnosis utilizing a computerized encoding system. Enters code(s) into medical necessity software to obtain medical necessity approval. Responsible for contacting the provider to validate diagnosis and/or obtain additional diagnoses if medical necessity is not met. Creates and processes Advanced Beneficiary Notices (ABNs) if applicable. Verifies insurance including copays, deductibles, and co-insurance. Calling for insurance benefits when needed. Informs patients or departments of the financial responsibilities. Directs patients to the Financial Counselor as indicated to discuss payment arrangements or financial assistance. May be asked to become a Super User for the current computer system, troubleshooting issues and performing table maintenance as needed. Maintains confidentiality and protects sensitive data at all times. Demonstrates exceptional customer service and interacts effectively with physicians, patients, visitors, staff, and the broader community. May be asked to perform other duties within the PFS department.

Requirements

Experience in health care office setting and/or customer service.
Certified Medical Assistant or similar degree with experience

Nice To Haves

2+ Years Experience
Certified Medical Assistant

Responsibilities

Scheduling patients
Obtaining prior authorization
Creating the estimate of services
Having financial conversations with patients and/or guardians
Assisting the patient, parent/guardian, or providers office with a friendly, courteous manner and high level of professionalism
Ensuring the accuracy and integrity of patient information and test orders
Maintaining a high level of confidentiality
Working independently and as a member of a team
Following safe work practices
Ensuring that all Amberwell procedures are followed in accordance with established policies
Demonstrating a knowledge of cultural diversity, the ability to provide care and service and exhibit the communication skills necessary to interact effectively with the patient/family/customer
Proactively serving as a patient advocate by always utilizing courteous and professional etiquette by answering the telephone promptly, reflecting a positive tone and speaking distinctly with poise, tact, and assurance
Coordinating with physicians, nurses, staff, patients, and other medical departments while setting up appointments, making sure prior authorization has been checked and/or received and orders are obtained prior to or immediately following the scheduling process
Validating the prior authorization CPT codes match the actual test that has been ordered, troubleshooting any discrepancies prior to placing the patient on the schedule
Attaching orders
Verifying medical necessity on all applicable patients scheduled by obtaining the diagnoses related to the procedure(s)
Assigning diagnosis code(s) for each diagnosis utilizing a computerized encoding system
Entering code(s) into medical necessity software to obtain medical necessity approval
Contacting the provider to validate diagnosis and/or obtain additional diagnoses if medical necessity is not met
Creating and processing Advanced Beneficiary Notices (ABNs) if applicable
Verifying insurance including copays, deductibles, and co-insurance
Calling for insurance benefits when needed
Informing patients or departments of the financial responsibilities
Directing patients to the Financial Counselor as indicated to discuss payment arrangements or financial assistance
Becoming a Super User for the current computer system, troubleshooting issues and performing table maintenance as needed
Demonstrating exceptional customer service and interacts effectively with physicians, patients, visitors, staff, and the broader community
Performing other duties within the PFS department