Prior Authorization/Centralized Scheduler, ONSITE

JOB DESCRIPTION:

Prior authorization and centralized scheduler are key members of the team. The scheduler will work under the direction of the Director of Patient Access.  The prior authorization/centralized scheduler position will be responsible for scheduling patients, obtaining prior authorization, creating the estimate of services, and having financial conversations with patients and/or guardians. These tasks are completed by assisting the patient, parent/guardian, or providers office with a friendly, courteous manner and high level of professionalism. Schedulers ensure the accuracy and integrity of patient information and test orders, while maintaining a high level of confidentiality.

Duties may include but are not limited to:

• Able to work independently and as a member of a team.
• Understand and follow safe work practices.
• Ensure that all Amberwell procedures are followed in accordance with established policies.
• Demonstrates a knowledge of cultural diversity, the ability to provide care and service and exhibit the communication skills necessary to interact effectively with the patient/family/customer.
• Proactively serves as a patient advocate by always utilizing courteous and professional etiquette by answering the telephone promptly, reflecting a positive tone and speaking distinctly with poise, tact, and assurance.
• Coordinate with physicians, nurses, staff, patients, and other medical departments while setting up appointments, making sure prior authorization has been checked and/or received and orders are obtained prior to or immediately following the scheduling process. Validates the prior authorization CPT codes match the actual test that has been ordered, troubleshooting any discrepancies prior to placing the patient on the schedule.
• Responsible for ensuring the accuracy and integrity of patient information and test orders, attaching orders, while maintaining a high level of confidentiality.
• Verify medical necessity on all applicable patients scheduled by obtaining the diagnoses related to the procedure(s). Assign diagnosis code(s) for each diagnosis utilizing a computerized encoding system. Enters code(s) into medical necessity software to obtain medical necessity approval.
• Responsible for contacting the provider to validate diagnosis and/or obtain additional diagnoses if medical necessity is not met. Creates and processes Advanced Beneficiary Notices (ABNs) if applicable.
• Verifies insurance including copays, deductibles, and co-insurance. Calling for insurance benefits when needed. Informs patients or departments of the financial responsibilities. Directs patients to the Financial Counselor as indicated to discuss payment arrangements or financial assistance.
• May be asked to become a Super User for the current computer system, troubleshooting issues and performing table maintenance as needed.
• Maintains confidentiality and protects sensitive data at all times.
• Demonstrates exceptional customer service and interacts effectively with physicians, patients, visitors, staff, and the broader community.
• May be asked to perform other duties within the PFS department.

ABOUT AMBERWELL HEALTH:

Amberwell Health is a healthcare system dedicated to improving the health and wellness of the communities we serve, providing compassionate healthcare with clinical excellence. Amberwell locations include several complete care facilities that provide a full spectrum of patient care services including inpatient, surgical, orthopedic, maternal, health at home, emergency care services. In addition, Amberwell clinic locations offer primary care and specialty care services. Amberwell Health supports service lines and locations across the system with a range of support services including radiology, laboratory, cardiopulmonary, rehabilitation therapy, occupational health, infusion, nutrition, pharmacy, administrative services, and many other specialty services.

AMBERWELL CULTURE:

Amazing Amberwell employees are at the heart of a workplace focused on competencies with our cultural values. Excellence in healthcare is expected and our patients deserve nothing less. Our culture competencies range from warm greetings in the hall to providing patients with “wow” experiences in each department. At Amberwell, we go beyond excellence to provide the unexpected.

At Amberwell, you will find a professional environment that values consistency, collaboration, and patient-first decision making. Servant leadership is both modeled and mentored, with a focus on regular appreciation. Amberwell employees enjoy many appreciation events and activities to help them know just how important they are to our organization, our patients, and our communities.

To learn more about Amberwell Health, our affiliated organizations, and available career opportunities, visit careers.amberwellhealth.org.

JOB QUALIFICATIONS:

• Experience:
  • Minimum Required Experience: Experience in health care office setting and/or customer service.
  • Preferred Experience: 2+ Years

• Education:
  • Minimum Required Education: Certified Medical Assistant or similar degree with experience

• Certifications:
  • Preferred Certifications: Certified Medical Assistant