Scheduler & Pre-Access Rep - Sleep Center Clinic

Advocate Health and Hospitals Corporation•Tinley Park, IL

10d•Onsite

About The Position

This role is responsible for collecting, analyzing, and recording accurate demographic and clinical information in the scheduling system, meeting or exceeding productivity standards. The position involves positively identifying patients, scheduling appointments based on patient preference and optimal site selection, and accurately entering all required patient data. Responsibilities include checking faxed orders, reviewing them for accuracy, and documenting when new or revised orders are needed. The role ensures proper test sequencing, manages scheduling conflicts, and communicates with departments to maintain current scheduling openings. Additionally, the position explains procedures, provides accurate preparation information, and gives patients directions for their appointment day. It also involves maintaining synchronicity between scheduling and registration systems, securing interpreters when needed, and collecting/analyzing demographic, insurance, and clinical data for pre-registration/preadmission. The role ensures patients are scheduled with proper authorization, collects necessary financial information, and performs revenue cycle activities to prevent payment denials and increase cash collections. It verifies insurance eligibility, communicates with insurance companies, and follows up on accident, injury, or third-party liability diagnoses. The position reviews Medicare outpatient testing, addresses payment obstacles for Medicaid patients, and communicates with relevant parties regarding pre-registration and financial clearance. It collects pre-visit deposits or secures payment promises, informs callers of insurance findings, and reviews accounts for completeness and accuracy. The role also indexes faxes and performs other assigned duties.

Requirements

HS diploma or equivalent.
2-3 years related experience, preferably in a healthcare setting (revenue cycle experience preferred), hospital, physician office or insurance company.
Applicable education may be substituted.
Basic knowledge of medical terminology.
Effective organizational and prioritization skills
Exhibits sophisticated interviewing, communication and negotiation skills.
Possesses intermediate math and business writing skills
Knowledge of office equipment
Computer literate
Demonstrated customer service skills.

Responsibilities

Collects, analyzes, and records accurate and compliant demographic and clinical information in the scheduling system.
Meets or exceeds productivity standards.
Positively identifies the patient before accessing existing medical record numbers or creating new patient entries.
Provides patients with site and appointment date and time options, scheduling per patient preference or first appointment at optimal site.
Accurately enters all required patient demographic and clinical data in scheduling application.
Checks receipt of faxed orders and reviews for accuracy.
Documents record if new or revised written orders are needed on day of service.
Schedules with proper test sequencing when multiple tests are ordered, ensures there are no clinical, equipment or physician conflicts.
Engages in frequent communication with all departments to ensure scheduling openings are current and time blocks are administered as needed.
Explains procedures and provides patients/customers with accurate preparation information prior to exam.
Ensures understanding of pre-procedure clinical requirements.
Provides directions for patients to follow on day of service and ensures understanding of where to park, where to check-in, when to arrive, etc.
Maintains synchronicity between the scheduling and registration systems when rescheduling, canceling or editing accounts.
Identifies and responds appropriately to callers' communication needs, secures interpreter to complete scheduling and documents record for future visit.
Accurately collects, records and analyzes all required demographic, insurance/financial and clinical data necessary to preregister/preadmit patients from all payer classes.
Meets standards for productivity defined as 100% scheduled patients pre-registered prior to arrival.
Scans (or ensures) printed orders into the patient’s account or validates the patient is to bring on the day of service.
Completes the MSP (Medicare Secondary Payer Questionnaire) thoroughly.
Uses appropriate insurance codes accounts when Medicare is deemed secondary to other insurance.
Performs an abbreviated screening of insurance benefits and attempts to fast pass pre-registered accounts when able.
Records accounts notes and appropriately codes accounts for hand-off to financial clearance.
Reviews physician orders and other documentation against Medicare payer coverage and medical necessity criteria; translates text into code and uses screening software to determine whether services being provided meet third-party requirements for payments.
Sends electronic requests to physicians to obtain additional diagnoses on orders as needed.
Identifies if authorization/prior approvals are required for scheduled services.
Requests and documents as appropriate.
Schedules patients without authorization at least three days out to allow sufficient time to financially clear account.
Escalates accounts to appropriate persons if time frame is shortened and account needs higher priority.
Pre-authorizes patient for services with insurance company.
Collects and records accurate and thorough patient, guarantor, insured and insurance information when preregistering patient accounts.
Pre-registers accounts using appropriate clinic and service codes; and establishes account parameters to ensure revenue is properly recorded and accurate bills are produced.
Performs revenue cycle activities that prevent payment denials, increase cash collections and assures appropriate financial disposition of account balances.
Meets defined standards for quality. i.e., all components of the pre-reg process must be completed pre-service, including discussions with patients when necessary. Accounts should require minimal registrar intervention on the actual date of service.
Verifies insurance eligibility, reviews and if applicable, notifies the patient’s primary, secondary and tertiary insurance companies of the scheduled service and obtains benefit information and service authorizations.
Follows up any accident, injury, or third party liability diagnosis appropriately and documents coverage determinations.
Reviews the pass/fail of Medicare patients’ outpatient testing per passed medical necessity guidelines and follows up with physician as necessary to request additional (if applicable) orders/diagnosis prior to a patient's service date
Identifies payment obstacles for Medicaid patients and takes appropriate action including following up on billing codes and other State specific program requirements
Communicates with appropriate persons regarding all aspects of pre-registration, registration, verification, precertification and date of service / insurance issues
Alerts Financial Counselors when presented with out of network plans, insurance denials, and high dollar deductible and out of pocket maximums
Enters thorough account notes in system and documents accounts with applicable financial clearance information
Enters verification flag in system as applicable
Contacts the patient/representative, physician, insurance company or others if additional information is needed to financially clear patients on the date of service.
Places reminder calls to pre-registered patients 24-48 hours prior to service date and ensures each accounts' financial clearance disposition is correct and easily identified for the date of service registrar.
Reviews reports to determine who needs reminder calls.
Refers to coordinator/manager any accounts that do not meet standards for financial clearence disposition.
Confirms service date/time/place with patients and reschedule services as needed.
Informs callers of insurance company findings (i.e. deductible, co-insurance and co-payment), collects pre-visit deposits or secures payment promises.
Provides patients with information about their arrival and service area needs. i.e., what time to arrive, where to park, where to go, what to bring with them. etc.
Review accounts for completeness and accuracy and updates account documentation/finanical cleareance disposition as needed.
Indexes and names faxes located in fax storage system.
Accepts and completes other duties and special projects as assigned.
Performs other duties as assigned.

Benefits

Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program