Prior Authorization/Centralized Scheduler, ONSITE

Amberwell Health Atchison-posted about 13 hours ago

Full-time

Onsite • Atchison, KS

251-500 employees

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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.

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.

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

2+ Years
Certified Medical Assistant

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Prior Authorization/Centralized Scheduler, ONSITE

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