Pre-Authorization Scheduling Coordinator Bariatric Clinic

Minimum Qualifications EDUCATION, CERTIFICATION, EXPERIENCE, AND/OR LICENSURE: High school diploma or equivalent required AND One year of recent experience in a physician/hospital scheduling and registration or business office environment OR; Completed Medical Assistant (MA) degree OR; Associate Degree. Core Duties and Responsibilities Receives physician and patient communications to schedule patients and manages the registration process. Responsible for accurate and timely interviewing of patients and/or relatives in a courteous manner to obtain registration data based upon comprehensive data elements to complete the registration process. May be scheduled to work various shifts based on departmental and patient needs. Schedules outpatient procedures via telephone with patients and offices in a courteous, professional manner. Coordinates multiple procedures patients have to ensure they are scheduled on the same day and within an appropriate time frame. Provides patients and offices with accurate instructions regarding the scheduled procedure (i.e., NPO, arrival time, where to arrive, etc.). Checks order documents for completeness and validates orders against scheduled services. Clearly documents activities and actions taken on accounts, including authorization, communication with patients, staff and other departments. Maintains scheduling and registration accuracy threshold of 95% as identified in audit processing. Performs prior authorization process by performing medical review and entering authorizations into system. Assists the billing department in researching and resolving rejected, incorrectly paid, and denied claims as requested. Multitasks and performs duties well while under pressure and while meeting deadlines. Obtains demographic, billing and insurance information from patient/family/legal guardian and correctly enters into the scheduling and registration/billing systems for service and claim processing. Uses applicable CPT and ICD-9 codes. Verifies insurance; validates pre‑cert/pre‑auth information after completion of insurance verification and records results in system. Performs other insurance‑related functions as required or necessary. Completes Medicare Secondary Payer forms, where applicable. Completes medical necessity screening. Verifies medical necessity for applicable payer and service. Cancels or reschedules patients in accordance with hospital workflows. Exercises proper stewardship through the appropriate use of supplies, equipment, and time. Follows hospital, state and federal guidelines for ensuring a safe environment for workers, patients and the public. Ensures compliance by staff to hospital, governmental and insurance regulations. Actively participates in in‑services, staff meetings, continuing education courses, hospital‑wide committees and other meetings as needed or required. Participates in the processes to assess and improve the services provided and compliance with regulatory requirements. Reports results of assessment and improvement processes to the appropriate administrative level. Performs other duties as assigned which support the mission and values of the organization. Accepts assignments within scope of practice, skill set and level of competence. Physical Requirements Must meet Department of Labor’s MEDIUM duty standard ( MEDIUM WORK- exerting up to 50 pounds of force occasionally, and/or up to 20 pounds of force frequently, and/or up to 10 pounds of force constantly). Able to bend, stoop, reach and be capable of normal rotation, standing and walking for an 8‑10 hour shift. Working Environment May be required to travel between facilities/buildings. Skills and Abilities Strong communication skills. Working knowledge of office equipment and computers. Excellent customer service and telephone etiquette. Demonstrates tact and diplomacy in dealing with others. Uses a computer keyboard, monitor and mouse. Answers telephones and transcribes messages. Communicates verbally, written and electronically with healthcare personnel, families and patients. Working knowledge of healthcare insurance plans. Working knowledge of hospital clinical departments and service protocols. General knowledge of hospital payment plan guidelines. General knowledge of healthcare coding practices. Experience and knowledge in admissions, registration, and insurance verification. Additional Job Information Scheduled Weekly Hours: 40 Exempt/Non-Exempt: (not specified) Shift: United States of America (Non-Exempt) Company: BMC Berkeley Medical Center Cost Center: 8470 BMC Bariatric & Metabolic Surgery Address: 2000 Foundation Way, Martinsburg, West Virginia Equal Opportunity Employer West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment. #J-18808-Ljbffr WVU Medicine Berkeley and Jefferson Medical Centers