Overview:
The Senior Patient Scheduling Representative is responsible for the verification and collection of patient demographic and insurance information by direct data entry to the electronic medical record during scheduling. S/he conducts either face-to-face or inbound/outbound telephonic interviews with the patient or authorized representative to secure information specific to requested services; accurately documenting the discussion and other referral/scheduling activities in the encounter. S/he a knowledgeable resource for ancillary or clinical departments related to Integrated Patient Scheduling questions or issues.
Demonstrates a customer-centric focus in all interactions with internal and external customers as well as an understanding of and ability to achieve performance standards as defined by Access Center Management.
This is a Remote position - "NAH reserves the right to make hiring decisions based in part on applicants' state of residence if outside the state of Arizona".
The primary location of this position is hybrid (remote and on site as needed).
Responsibilities:
Patient Referral and Scheduling
* Demonstrates a thorough knowledge of and ability to navigate web-based products or system applications required for referrals or scheduling.
* Accurate identification of patient for direct data entry of required clinical, demographic, and insurance information using web based products, system applications and internal resources to the electronic medical record during the referral process or for appointment booking of assigned services.
* Provides thorough explanation of scheduled procedures and patient instructions that are necessary for conducting services.
* Ensures system documentation specific to the patient visit is entered and accurately reflects activities related to clinical, demographic and insurance information.
* Provides accurate information to patients regarding referral process and future steps fo individual plan of care.
* Performs medical necessity checking for identified services and secures required ABN documentation as appropriate.
* Demonstrates thorough understanding of compliance standards required within a healthcare environment including EMTALA and HIPAA-Privacy Patient Confidentiality regulations.
* When required and/or requested by Integrated Patient Scheduling, has the knowledge of and ability to perform Scheduling, Radiology and Insurance audits as well as any/all other Integrated Patient Scheduling functions as defined Integrated Patient Scheduling management.
Eligibility/Authorization Management
* Accurate identification and selection of insurance carrier in the patient medical record for specified dates of medical services.
* Navigation of web-based products or system applications and internal resources to initiate and document insurance eligibility, benefit details, and authorization requirements.
* Performs required notifications to ensure online referrals for identified outpatient diagnostic or medical services are secured and documented.
* Demonstrates advanced knowledge of CPT, ICD10 coding, and physician order requirements as required for medical services including determinations for medical necessity.
Financial Counseling
* Demonstrates advanced knowledge of regulatory or Third Party Payer insurance requirements including Medicare, AHCCCS/Medicaid, Workers Comp and other commercial payers.
* Educates the patient on insurance eligibility, coverage, authorization requirements and estimated services charges.
Revenue Cycle Support
* Acts as a resource for other departments for referrals/scheduled services related to data entry of patient account fields and provider order/referral requirements.
* Monitors and analyzes Integrated Patient Scheduling reports and system work lists to ensure accuracy of patient record and that all process steps, insurance requirements, and compliance standards have been met for service types.
Compliance/Safety
* Responsible for reporting any safety related incident in a timely fashion through the Midas/RDE tool; attends all safety related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner.
* Stays current and complies with state and federal regulations/statutes and company policies that impact the employees area of responsibility.
* If required for position, ensures all certifications and/or licenses are up-to-date and valid prior to expiration dates.
* Completes all company mandatory modules and required job specific training in the specified time frame.
Qualifications:
Education
High School Diploma or GED- Required
Associate’s Degree – Preferred
Medical Terminology Coursework- Preferred
Certification & Licensures
Fingerprinted
Fingerprint clearance cards are needed for those who will work onsite within any NAHMG clinics. This is not required for remote employees.
Experience
At least nine months of demonstrated proficiency at the Patient Scheduling Representative level - Required
Advanced level of computer skills including keyboarding of 25 - 35 words per minute- Preferred
Proficiency in Microsoft applications (Excel, Word, PowerPoint)- Required
