Authorizations Specialist and Centralized Scheduler

Job Summary:

This position will continuously interact with patients and provider offices, both external and internal, to schedule procedures and diagnostic imaging, tests, with a primary focus on surgery and cardiovascular. This position will also provide scheduling, surgical and financial instructions to patients, while supporting the providers and enforcing the collection policy and procedures for the hospital. The position is responsible to obtain all prior authorizations for surgeries, procedures, and diagnostic imaging primarily for the Orthopedic, Pain, and Prolia, and Infusion Clinics. This position requires extensive phone use along with the ability to multi-task and ability to pay attention to detail. Employees must demonstrate professionalism and courtesy in all interactions to ensure an exceptional customer experience is provided to all callers.

Supervisory Responsibilities:

• None

Duties/Responsibilities:

• Schedule hospital-based surgeries and medical procedures, for patients with appropriate provider and time/location slot, utilizing appropriate software. 
• Schedule diagnostic and imaging tests to be completed at GRMC. Schedule hospital based medical procedures, tests and imaging ensuring available time is utilized to maximum efficiency.
• Schedule Prolia and other injections to be provided in the Specialty Clinic.
• Effectively use the current operating system for Electronic Medical Records.
• Effectively utilize clinical knowledge when determining if appointment is consistent with the diagnosis/indications indicated by the provider. 
• Obtain appropriate demographic and insurance information from the patient.
• Complete insurance verification, authorization/referral needs. Obtain authorizations/referrals, if needed. Ensures the required authorization and referral is on- file before the patient’s scheduled appointment.
• Review patient’s medical history and insurance coverage for approval.
• Contact referring physician for additional information as needed.
• Provide accurate, detailed information to patients regarding test preparations, time of patients scheduled arrival, and any other directional information needed; takes appropriate action in responding to questions from patients.
• Confirm patient’s insurance provider and either obtains prior authorizations or communicates need for prior authorization to appropriate parties, as needed. 
• Maintain confidentiality of patient information in compliance with HIPAA.
• Maintain compliance with relevant regulations and payer specific guidelines.
• Complete pre-procedure phone calls and confirms appointment times with patients via telephone.
• Assist with, complete, and provide coding documentation to ensure accurate coding to maximize revenue and minimize claim denials.
• Collect co-pays and co-insurance for approved services when needed.
• Perform all aspects of patient care in an environment that organizes patient safety and reduces the likelihood of medical/health care errors.
• Communicate to referring provider any delays.
• Provide exemplary customer service.
• Cooperate with other personnel to achieve departmental objectives and maintain good employee relations, inter-departmental objectives and infection control policies.
• Attend meetings as required.
• Maintain compliance with relevant regulations, including HIPAA, and payer-specific guidelines
• Perform other related duties to benefit the mission of the organization.

Required Skills/Abilities: 

• Able to provide appropriate communication and follow-up to the teams
• Strong interpersonal, verbal, and written communication skills to interact with payers and internal departments
• Ability to prioritize tasks effectively and manage time in a fast-paced environment
• Intermediate computer skills, including but not limited to: Microsoft Office, electronic medical record, and email
• Strong attention to detail
• Must be committed to quality and patient safety at all times
• Demonstrate sound knowledge of anatomy and, at a minimum, a basic understanding of surgical procedures and diagnostic imaging terminology; medical terminology understanding a plus
• Excellent command / highly proficient in spoken and written English; bilingual in Spanish preferred
• Must be effective at adjusting to change, prioritizing duties, handling stress and effectively communicating face-to-face and/or over the telephone
• Must be able to work independently, and flexibly, and as a part of a multidisciplinary team
• Must be able to manage several interruptions throughout the shift
• Must have strong time management skills
• Must be able to work under pressure while interacting in a helpful, courteous manner with a high degree of patient contact

Education and Experience:

• Highschool diploma or GED required; Associate Degree or higher in a related field preferred
• 2+ years of experience in healthcare required
• Clinical licensure or certification preferred
• Experience or certification in coding and billing preferred

Physical and Mental Requirements: 

• Prolonged periods sitting at a desk and working on a computer
• Must be able to lift up to 25 pounds at times
• Must be able to navigate various departments of the organization’s physical premises
• Sufficient hearing, vision, and dexterity to perform duties safely
• Stress Level: Moderate to high

OSHA Classification:

• Category III: Tasks that involve no exposure to blood, body fluids, or tissues, and Category I tasks are not a condition of employment.
• The normal work routine involves no exposure to blood, body fluids, or tissues (although situations can be imagined or hypothesized under which anyone, anywhere might encounter potential exposure to body fluids). Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency medical care or first-aid or to be potentially exposed in some other way. Tasks that involve handling implements or utensils, use of public or shared bathroom facilities or telephone, and personal contacts such as handshaking are Category III tasks.