Pre-Certification Procedure Scheduler

Description

General Job Summary: Vital to the success of organization with providing OrthoCincy’s patients and visitors with a premier orthopaedic experience and focusing on their individual needs. Responsible for pre-certifying tests and procedures. 

Essential Job Functions:

1. Provides      excellent customer service to patients by addressing their concerns and      providing necessary information.
2. Prepares,      organizes, prioritizes documents and communicates all necessary paperwork      and information needed by insurance companies for the prior authorization      process. 
3. Ability      to achieve minimal denials due to prior authorization accuracy. 
4. Obtain      authorizations for imaging procedures, surgical procedures, and injections      from various insurance providers. 
5. Verify      patients' insurance benefits and eligibility and obtain the required      pre-authorization for treatment or services.
6. Provides      patient education per provider protocol.
7. Establish      and maintain effective working relationships with patients, providers,      co-workers and external contacts regarding procedures and testing. 
8. Maintain      patient information in an electronic health records and practice      management system. 
9. Answer      messages, emails, and/or voice mails in a timely and professional manner.
10. Demonstrates      sound judgement by notifying providers/teams regarding questionable      findings and concerns in an urgent manner.
11. Compliance      with HIPAA guidelines.
12. Takes      initiative in performing additional tasks that may be necessary or in the      best interest of the practice.

Requirements

Education/ Experience: High school diploma or equivalent required. Medical certification required with two to five years’ experience as a Medical Assistant preferred. CPR/AED and First Aid Certification preferred.

Other Requirements. Must be patient care oriented with a team environment focus. Schedules will change as department needs change, including overtime and weekends. Weekly travel between locations.

Performance Requirements:

Knowledge:

1. Knowledge      of OrthoCincy’s Mission, Vision and Values. 
2. Knowledge      of customer service principles and techniques.
3. Knowledge      of electronic health records and practice management systems.
4. Knowledge      of medical terminology. 
5. Knowledge      of HIPAA guidelines.
6. General      knowledge of insurance guidelines.

Skills:

1. Strong      interpersonal and teamwork skills.
2. Strong      critical thinking and decision-making skills.
3. Strong      customer service skills.
4. Proficiency      in computer systems and software used for pre-certification purposes. 
5. Strong communication skills      in a professional manner during stressful and sensitive situations with      patients of all ages. 

Abilities:

1. Ability      to project a pleasant and professional image. 
2. Ability      to be self-directed and motivated in order to proactively plan,      prioritize, and complete tasks.
3. Ability      to demonstrate compassion while caring for others
4. Ability      to analyze situations and respond appropriately.
5. Ability      to consistently demonstrate ability to respond to changing situations in a      flexible manner in order to meet current needs, such as reprioritizing      work as necessary.
6. Demonstrates regular, consistent, and punctual      attendance. 
7. Exhibits      desire to continuously learn, improve service delivery, and work in a team      environment. 

Equipment Operated: Standard office equipment.

Work Environment: Medical office.

Mental/Physical Requirements: Involves sitting approximately 90 percent of the day. Repetitive data entry. Must be able to remain focused and attentive without distractions (i.e. personal devices).