Obtains and/or verifies demographic, clinical, financial, and insurance information in the process of appointment making for patient tests and procedures, pre-registering and financial clearing for service delivery. Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance. Additionally, the incumbent obtains and processes signed physician orders to ensure clinical documentation for care delivery.
The incumbent conducts online insurance eligibility/benefit verification, pre-certification/authorization, referral clearance and financial education on designated cases. As appropriate, the incumbent notifies patient/guarantor and collects patient liabilities, and refers appropriate cases to resource counseling for follow-up and consultation. Major Job Functions The following is a summary of the major essential functions of this job.
The incumbent may perform other duties, both major and minor, that are not mentioned below. In addition, specific functions may change from time to time: Receive orders and schedule outpatient appointments for all modalities except biopsy and special procedures and all radiology outpatient facilities Determines proper scheduling requirements and/or limitations according to requested tests/procedures and schedules resources (equipment, staff, room, etc.) Coordinates add-on and same-day appointments as required Ensures proper test sequencing with minimal patient delays, when multiple testing is required.
Performs insurance eligibility/benefit verification, utilizing a variety of mechanisms (EDI transactions, web access and by calling payers) and documenting information within the appropriate registration system; supporting with reference number. Pre-registers the patient for upcoming visit(s). Calls patient to remind of appointment date, time, location, and preparation for procedures following protocols; as well as informs the patient of their financial responsibility, answer questions and give directions.
Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance. Informs patient/guarantor of their liabilities and collects appropriate patient co-payments, co-insurances, deductibles, deposits and outstanding balances at the point of pre-registration. Provides patient, family and physician office education during scheduling process to inform them of preparations needed for diagnostic testing and proper scheduling instructions Sends and/or communicates appointment confirmation to referring office Reconciles charge reports daily and communicates errors to staff Other duties as assigned
The following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job: Education and Formal Training : High school diploma or equivalent required College courses in Business or Health Care Administration and/or Computer Technology preferred Medical terminology required within one year of employment Work
1 year insurance/clerical experience within a hospital or medical office setting preferred Knowledge, Skills, and Abilities Required : Proficiency in reading, writing, and speaking the English language Must pass pre-employment testing and post-training testing Must have knowledge of insurance and collection of payments Must have experience with Microsoft software Must possess excellent verbal and written communication skills, customer service skills and problem-solving abilities Must be multi-skilled with the ability to appropriately handle complexity and stress with the changing needs of the patients, families, visitors, and the Health System May be required to periodically rotate shifts and regular days off All system employees must have the flexibility to meet the department hours of operation Physical
Must be able to communicate orally, see, and hear to collect information Must have dexterity to operate office equipment Position operates in an office, call center environment Work area is well-lit, temperature controlled and free from hazards The incumbent is subject to eyestrain due to the many hours spent looking at a CRT screen The noise level is low to moderate Answers telephone calls, uses personal computer and other business machines extensively Bends, reaches, pushes and pulls file drawers to file records and reports Regularly lift or move up to 10 pounds, frequently lift or move up to 25 pounds and occasionally lift or move up to 50 pounds Required Licenses and Certifications Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity