Scheduler & Pre Access Representative

American Addiction Centers•Tinley Park, IL

1d•Remote

About The Position

The Scheduler & Pre Access Representative is responsible for collecting, analyzing, and recording accurate demographic and clinical information in the scheduling system. This role involves verifying patient information, scheduling appointments, explaining procedures, and ensuring patients understand pre-procedure requirements and day-of-service instructions. Additionally, the representative performs pre-registration and pre-admission activities, including collecting demographic, insurance, and clinical data, scanning orders, completing necessary questionnaires, screening insurance benefits, and determining if authorization or prior approvals are required for scheduled services. They also perform revenue cycle activities to prevent payment denials and increase cash collections, verify insurance eligibility, and communicate with patients and insurance companies regarding benefits and authorizations. The role includes following up on payment obstacles, alerting financial counselors to potential issues, and ensuring all financial clearance information is correct and easily identifiable for the date of service registrar. Reminder calls are made to patients, and accounts are reviewed for completeness and accuracy. Other duties and special projects as assigned are also part of this role.

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

Using AIDET, collects, analyzes and records accurate and compliant demographic and clinical information in the scheduling system.
Meets or exceeds productivity standards.
Using approved identification 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 respond 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.
Perfoms 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

Comprehensive suite of Total Rewards: benefits and well-being programs
Competitive compensation
Generous retirement offerings
Programs that invest in your career development
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