Medical Assistant/Surgical Scheduler, Thoracic Surgery

Job Description

The Medical Assistant/Surgical Scheduler will assist in the delivery of care in the ambulatory setting under the direct supervision of a licensed nurse, APP, or physician. The position is responsible for functions and activities related to scheduling and obtaining precertification/authorization for surgical, therapeutic and diagnostic procedures for patients of Cardiology, including but not limited to accurate and complete patient registration in the electronic scheduling and billing system, insurance verification and updates, contacting third party payers via phone, fax and internet to obtain necessary approvals and communicating results to the patient, physician and other staff. This position requires a working knowledge of Medicare, Medicaid and Commercial insurance plans, authorization processes and medical terminology. It requires strong verbal and written communication, customer service and organizational skills.

Major Responsibilities:

Provide patient care in outpatient physician practice under the direction of the practicing physician, physician assistant

Assist with other clinical and clerical duties to ensure optimization of patient experience within the practice.

Prepares patients for the health care visit by directing and/or accompanying them to the examining room; providing examination gowns and drapes; helping them to position themselves for the examination and/or treatment; arranging examining room instruments, supplies, and equipment.

Verifies patient information by interviewing patient; reviewing and/or recording medical history; taking vital signs; confirming purpose of visit or treatment.

Performs timely insurance verification/eligibility processes utilizing the practice management system, automated electronic eligibility functionality, various reports, and third party payer websites and customer service telephone contacts related to ordered/scheduled therapeutic procedures, medications, surgeries and diagnostic testing.

Ensures that all insurance, demographic and eligibility information is obtained and entered into the system in an accurate manner per established Practice policies and procedures. Communicates with patient to identify missing information and make corrections as needed.

Contacts insurance companies on behalf of the Practice and the patient to initiate and complete the precertification/authorization process as required by the patient's insurance company for ordered procedures, surgeries and diagnostic testing.

Coordinates with insurance companies, physicians and patients to provide all appropriate documentation required for the precertification/authorization of services including but not limited to the medical record, procedural (CPT) and diagnostic (ICD10) coding, and Letters Of Medical necessity per the established procedures of each insurance carrier and the Practice.

Performs and documents tracking and follow up on all open precertification/authorization requests in a timely manner. Provides additional information to carriers as requested. Coordinates peer review requests from insurance carriers with the ordering physician.

Notifies physician and other Practice staff and/or patient when services are not approved. Knows process and protocols for appealing precertification decisions and coordinates appropriate response as determined by the physician.

Keeps records of all activities related to the precertification/authorization process including but not limited to method of contact, dates of follow up, contacts and phone numbers and all reference numbers. Documents information given or received to support actions taken.

Documents approval/denial of precertification/authorization for services in the electronic medical record per established policies and procedures. Scans appropriate documents to the patient's chart for reference.

Develops and maintains a working knowledge of the procedures performed and ordered by the Practice. Has working knowledge of CPT and DX coding.

Research third party payer requirements and processes for precertification/authorization requirements pertaining to services provided by the Practice. Develops and maintains reference guides and resources related to processes. Communicates changes in authorization processes, insurance policies and billing requirements to appropriate Practice staff.

Identifies all patients without third party financial benefits and directs them for financial counseling according to Financial Counseling and Revenue Cycle policies and procedures.

Performs other duties as assigned

Qualifications/Requirements:

• High School Diploma or equivalent required.
• Certification or Diploma from accredited Medical Assistant school/program
• National Certification preferred.
• Two years job experience preferred.
• Heart Saver Certification (BLS) required
• Demonstrate basic computer skills.
• Effective communication skills, both verbal and written English proficiency required
• Demonstrate willingness to work in a team environment.
• Demonstrate flexibility due to unexpected changes in workload.
• Demonstrate ability to work independently and as a team player.
• Strong organizational skills.
• Superior customer service skills.