Central Scheduling & Eligibility Specialist-Clinic

Job Description

Job Description

Job Summary:  Coordinates clinic appointments, verifies insurance eligibility and benefits, and completes pre-registration and registration to support timely access to care. Serves as a point of contact for patients, referring offices, clinic staff, and ancillary departments. Identifies and resolves scheduling and insurance concerns before the visit whenever possible, explains estimated patient responsibility, and collects payments according to policy. Provides clinic reception and administrative support as assigned while supporting the mission and philosophy of White River Health. This position has no supervisory responsibilities.

Job Duties:

§ Schedule, reschedule, and cancel clinic appointments and assigned diagnostic services using established provider templates, appointment types, service locations, and scheduling guidelines. Coordinate appointments for visiting or traveling specialty providers as assigned.

§ Review incoming orders and referrals for required patient information, provider information, requested services, and supporting documentation. Contact the ordering or referring office for missing or unclear information and route clinical questions to appropriate clinical staff.

§ Maintain scheduling worklists, referral queues, and appointment records. Document outreach attempts, scheduling status, cancellations, and follow-up needs. Monitor outstanding items and communicate delays or barriers to the appropriate leader.

§ Provide patients with appointment dates, times, locations, arrival instructions, and approved preparation instructions. Coordinate schedule changes with patients, providers, and departments and help fill available appointments according to established guidelines.

§ Verify patient identity using approved identifiers and appropriate identification documents. Obtain and enter accurate demographic, contact, guarantor, subscriber, insurance, and referring provider information in the appropriate system.

§ Complete pre-registration, registration, and clinic check-in and check-out as assigned. Support registration for diagnostic services at the clinic location as applicable. Identify potential duplicate records and follow the established process for correction.

§ Request insurance cards at each date of service and verify information from the front and back of the card. Scan identification, insurance cards, orders, referrals, signed forms, and other required documents into the correct chart categories.

§ Verify active insurance coverage and benefits before scheduled services and update verification when required. Use the electronic eligibility system, payer websites, or telephone contact and document the verification results.

§ Confirm the correct payer, plan, financial class, subscriber information, coordination of benefits, and applicable patient responsibility. Identify network status, PCP requirements, referral requirements, and authorization requirements for the scheduled service.

§ Verify Medicaid coverage and assist with PCP requirements according to established payer procedures. Identify coverage discrepancies or inactive coverage and work with the patient, payer, referring office, and appropriate staff to resolve them.

§ Confirm required referrals and authorizations are available, accurate, and applicable to the service, provider, location, and date. Obtain or coordinate authorization as assigned and document reference numbers, approved services, and effective dates. Escalate unresolved requirements before the visit according to policy.

§ Perform assigned medical necessity screening and obtain required notices or acknowledgments when applicable under established policy. Refer questions requiring clinical judgment or coding clarification to the appropriate staff.

§ Explain insurance limitations, network concerns, and estimated financial responsibility using approved education and scripting. Follow established procedures for patients with unresolved coverage or financial clearance concerns and refer patients to financial counseling when appropriate.

§ Prepare or obtain estimates when applicable. Request and process copayments, deductibles, coinsurance, deposits, and outstanding balances according to policy. Issue receipts, post payments accurately, safeguard funds, and complete reconciliation and deposit procedures as assigned.

§ Answer clinic and scheduling telephone calls, relay messages accurately, and direct patients and callers to the appropriate staff. Coordinate with providers, nurses, referring offices, registration, scheduling, and authorization teams to support continuity of the appointment process.

§ Provide nonclinical clinic support as assigned, including preparing administrative visit materials, distributing forms, monitoring patient arrival status, and communicating patient flow concerns to clinic staff.

§ Review daily work for accuracy and completeness, resolve assigned registration or eligibility edits, and correct errors promptly. Document incomplete information and follow up on outstanding items.

§ Participate in orientation, training, and cross-training. Maintain equipment and supplies, assist coworkers with coverage, and perform other related duties assigned by supervision.

Qualifications:

Education:  High school diploma or equivalent.

Training and Experience:  Previous experience in customer service, patient registration, healthcare scheduling, insurance verification, or a medical office. Healthcare scheduling and eligibility experience preferred. Knowledge of medical terminology or willingness to complete required training.

Job Knowledge:  Ability to use electronic scheduling and registration systems, payer websites, and standard office equipment. Basic understanding of insurance terminology, eligibility, benefits, referrals, authorizations, and patient financial responsibility. Accurate data entry and clear verbal and written communication skills, including correct spelling and grammar.

Essentials:

§ Provide courteous, respectful, and compassionate service to patients, families, providers, coworkers, and the public. Handle difficult situations tactfully and use service recovery procedures when appropriate.

§ Follow oral and written instructions, manage multiple tasks, and prioritize work according to appointment dates, service needs, standards, and deadlines. Work independently and as part of a team, use sound judgment, and follow the chain of command when assistance is needed.

§ Maintain confidentiality of patient, employee, and organizational information. Access electronic patient health information only as authorized; system access is defined through the established security clearance process.

§ Accept new responsibilities with openness and cooperation, assist coworkers, and identify opportunities to improve scheduling accuracy, financial clearance, and patient service.

§ Follow safety, infection control, and emergency procedures. Know the location and proper use of fire extinguishers and job-related equipment. Keep work areas neat, clean, and organized.

§ Report to work fit for duty and comply with organizational conduct, attendance, timekeeping, dress code, and identification badge requirements. Remain flexible to accommodate assigned schedules and coverage needs.

§ Complete required education and competencies and participate in department meetings, training, and drills according to organizational expectations.

Physical Demands:  Duties require extended computer use, accurate keyboard and mouse operation, use of standard office equipment, and communication in person and by telephone. Work includes sitting, standing, walking within the clinic, and obtaining information or signatures from patients as assigned. Visual, auditory, and tactile abilities are needed to perform job functions. The work environment includes regular contact with patients, families, staff, and the public.