Representative, Practice Concierge-Radiology Outpatient Clinic-Full Time Days

Mary Washington Healthcare•Fredericksburg, VA

11d

About The Position

Start the day excited to make a difference…end the day knowing you did. Come join our team. Job Summary: This position is responsible for accurately performing Concierge functions, including scheduling , pre-registration, insurance verification, referrals and pre-certification. Essential Functions & Responsibilities: Performs accurately and timely scheduling of assigned procedures in accordance with applicable department specifications and physician script order. Interviews and follows up with patients who cancel procedure appointments or are no-shows. Assists physician practice with re-arranging the schedule as directed and notifies appropriate parties. Refers concerns/problems in scheduling cases to Specialty Coordinator, Resource Team, then to Administrative Manager/Supervisor as needed. Schedules/pre-registers appropriate pre-admission testing services; expedites services from other departments. Provides and maintains clinical documentation necessary for securing insurance authorization. Monitors reports in accordance with insurance verification and authorization procedures. Processes insurance verifications through various systems and websites Performs all aspects of the insurance verification process for Medicare, Medicaid, and commercial insurance payers to ensure compliance and appropriate assignment for the coordination of benefits. Obtains authorizations from insurance companies/physician offices. Certifies that the authorization has not expired, complete and accurate information is entered into the patient accounting system, and the date of service and facility name are consistent with the authorization. Coordinates peer to peer reviews as needed between the physician and the insurance company. Coordinates and communicates referrals, pre-authorizations, network benefits, out of network benefits, and patient waivers. Obtains the information necessary to provide financial clearance and successfully secures accounts for services in a timely manner by utilizing on-line resources, websites, telephone, etc. Provides price quotes and estimates. Collects diagnosis information and CPT/HCPCS codes from physician’s offices at the time of scheduling to aid in insurance verification and pre-authorization/certification process. Collaborates with internal associates and departments to financially secure the encounter. Responsible for keeping up to date with insurance authorization requirements and changes. Performs monthly insurance verifications. Assists with communicating patient/guarantor financial responsibility, co-pay, deductible and/or self-pay deposits. Maintains documentation necessary for compliance with state, federal and other regulatory agency requirements. Communicates operational activities, issues, and audit findings with appropriate leadership on a regular and timely basis. Identifies and recommends process improvements. Provides coverage for Office Coordinator staff as needed. Performs other duties as assigned.

Requirements

High school diploma or equivalent GED required.
A minimum of two years’ experience in patient scheduling, registration or healthcare billing required.
Proficiency with electronic medical record software applications, computers, telephones, fax machines, and the use of various software applications required.
Ability to prioritize and perform work in an organized, efficient, and effective manner without on-site supervision and direction is required.

Nice To Haves

Familiarity with Mary Washington Healthcare’s IT systems preferred.
Experience in data entry, customer service, collections and medical terminology preferred.

Responsibilities

Performs accurately and timely scheduling of assigned procedures in accordance with applicable department specifications and physician script order.
Interviews and follows up with patients who cancel procedure appointments or are no-shows.
Assists physician practice with re-arranging the schedule as directed and notifies appropriate parties.
Refers concerns/problems in scheduling cases to Specialty Coordinator, Resource Team, then to Administrative Manager/Supervisor as needed.
Schedules/pre-registers appropriate pre-admission testing services; expedites services from other departments.
Provides and maintains clinical documentation necessary for securing insurance authorization.
Monitors reports in accordance with insurance verification and authorization procedures.
Processes insurance verifications through various systems and websites
Performs all aspects of the insurance verification process for Medicare, Medicaid, and commercial insurance payers to ensure compliance and appropriate assignment for the coordination of benefits.
Obtains authorizations from insurance companies/physician offices.
Certifies that the authorization has not expired, complete and accurate information is entered into the patient accounting system, and the date of service and facility name are consistent with the authorization.
Coordinates peer to peer reviews as needed between the physician and the insurance company.
Coordinates and communicates referrals, pre-authorizations, network benefits, out of network benefits, and patient waivers.
Obtains the information necessary to provide financial clearance and successfully secures accounts for services in a timely manner by utilizing on-line resources, websites, telephone, etc.
Provides price quotes and estimates.
Collects diagnosis information and CPT/HCPCS codes from physician’s offices at the time of scheduling to aid in insurance verification and pre-authorization/certification process.
Collaborates with internal associates and departments to financially secure the encounter.
Responsible for keeping up to date with insurance authorization requirements and changes.
Performs monthly insurance verifications.
Assists with communicating patient/guarantor financial responsibility, co-pay, deductible and/or self-pay deposits.
Maintains documentation necessary for compliance with state, federal and other regulatory agency requirements.
Communicates operational activities, issues, and audit findings with appropriate leadership on a regular and timely basis.
Identifies and recommends process improvements.
Provides coverage for Office Coordinator staff as needed.
Performs other duties as assigned.