Invasive Scheduling Coordinator-COR221
- Req #: 2401325
- Facility Name: Catholic Medical Center
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Facility Address:
100 McGregor StreetManchester,NH
- Job Shift: Day
- Posted Date: 12/24/2024
POSITION SUMMRY:
Assumes responsibility for all facets of Invasive Scheduling, scheduling procedures, answering incoming calls, obtaining prior authorizations and other duties as assigned in accordance with the Joint Commission, NCQA and government standards, as well as policies and procedures of the Cardiology practice.
DUTIES AND RESPONSIBILITIES:
Under the direct supervision of the Practice Manager and within established policies and procedures, the incumbent performs the following functions:
1. Essential Functions:
• Acts as the liaison between insurance plans/carriers and/or third party representative and our clinical staff and providers to ensure any requests that have gone "peer-to-peer" obtain proper review by appropriate level of clinical team. Once "peer-to-peer" has been completed and an approval is in place, notifying appropriate staff of approval notification.
• Assist with medical necessity documentation to expedite approvals and ensure that appropriate authorization/pre-certification are obtained.
• Manages correspondence with insurance companies, physicians, and patients as required.
Secondary Functions:
KNOWLEDGE, SKILLS AND ABILITIES:
Individuals must possess the knowledge, skills and abilities listed, or be able to explain and demonstrate the essential functions of the job. With or without reasonable accommodation, using some other combination of skills and abilities to possess the necessary physical requirements. Aid of mechanical devices to safely perform the essential functions of the job:
1. Physical requirements include the ability to extend hand(s) and arm(s) in any direction; raise objects from a lower to a higher position or move objects horizontally from position to position; pick, pinch, type or otherwise work with fingers rather than the whole hand or arm.
2. Ability to express or exchange ideas by means of the spoken word. Ability to convey detailed or important spoken instructions and to illicit information from patients, physicians, and other employees.
3. Ability to receive detailed information through oral communication and make fine discriminations in sound.
4. Ability to perform routine or repetitive duties working from detailed instructions and under standard procedures. Requires the making of minor decisions.
5. Ability to endure periods of heavy workload or stress.
6. Ability to work with frequent interruptions and respond appropriately to unexpected situations.
7. Ability to interact with irate customers.
8. Ability to interact with physicians and staff and participate as a team member with individuals inside and outside the department.
9. Visual acuity sufficient for work which deals largely with preparing data and figures, accounting, transcription, computer terminal operation, extensive reading and visual inspection of small parts/devices.
10. Ability to have general computer knowledge and skills; ability to perform basic math; working knowledge of ICD-10 and CPT coding and insurance procedures.
11. Ability to exert up to 10 pounds of force frequently and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.
12. Individuals are required to refrain from participating in any activities that could be construed as fraud and abuse. Requires the ability to follow Catholic Medical Center's Standards of Business Conduct in any instance where you feel there is suspicion of fraud or abuse, or a violation of the law. Requires that suspicion or knowledge of any person's violation of the Code be reported to the Corporate Compliance Officer. The extent to which you comply with the requirements contained within the Code will be a factor in evaluating your overall job performance.
OSHA RATING: Category II (No exposure to blood borne pathogens)
PHI ACCESS: Complete
WORK SCHEDULE:
Generally, Monday through Friday, days.
QUALIFICATIONS:
Education:
• High school diploma or equivalent.
Experience:
• Two to three years' experience in health care setting performing similar work activities including, but not limited to scheduling procedures and prior authorization knowledge.
Assumes responsibility for all facets of Invasive Scheduling, scheduling procedures, answering incoming calls, obtaining prior authorizations and other duties as assigned in accordance with the Joint Commission, NCQA and government standards, as well as policies and procedures of the Cardiology practice.
DUTIES AND RESPONSIBILITIES:
Under the direct supervision of the Practice Manager and within established policies and procedures, the incumbent performs the following functions:
1. Essential Functions:
- Schedules procedures and related tests with appropriate hospital departments. Completes and faxes appropriate paperwork to the Admissions department.
- Ensures insurance information is accurate, reaching out to patients to update when needed.
- Receives incoming telephone calls, either directly or via transfer from other departments.
- Takes messages to include appropriate caller information when obtaining prior authorizations.
- Attends weekly EP Lab and Cath Lab meetings, presenting up to date schedule information to ensure provider and Lab schedules coincide.
- Contact insurance plans/carriers or third party representative via telephone or on-line submission to obtain authorizations, pre-certifications as necessary.
- Reviews accuracy and completeness of information requested and ensures that all supporting documents are present for insurance pans/carriers and/or third party representatives.
- Ability to project strong knowledge of regulatory standards and compliance requirements to effectively communicate with insurance plans/carriers and third party representatives.
- Obtains proper clinical documentation and faxes documentation for insurance plans/carriers and third party representative for clinical review on all pending prior authorization/pre-certification requests in a pending status.
- Contacts insurance plans/carriers or third party representatives to close pending cases either by review of clinical documentation provided to them or by having case need further clinical review by an approved member of our clinical staff (example, RN or MD/APP).
• Acts as the liaison between insurance plans/carriers and/or third party representative and our clinical staff and providers to ensure any requests that have gone "peer-to-peer" obtain proper review by appropriate level of clinical team. Once "peer-to-peer" has been completed and an approval is in place, notifying appropriate staff of approval notification.
• Assist with medical necessity documentation to expedite approvals and ensure that appropriate authorization/pre-certification are obtained.
- Communicates with various staff members at our satellite locations regarding prior authorizations.
- Monitors and maintains NEHVI scheduling inbox on a daily basis.
- Monitors and maintains the Order Tracking in EMR
• Manages correspondence with insurance companies, physicians, and patients as required.
- Interacts and communicates professionally with co-workers, management and patients.
- Interacts with patients regarding complaints for effective and immediate response and resolution. Refers to Practice Manager as appropriate.
- Ensures confidentiality of employee, legal, client, budget, and all other company matters.
Secondary Functions:
- Assists in orientation of new employees to office functions, shares pertinent information and effectively teaches others to perform tasks accurately and effectively.
- Participates in an appropriate role in disasters, fire drills, fires and other emergency situations.
- Exercises care in the operation and use of equipment and reference materials. Performs routine cleaning and preventative maintenance to ensure continued functioning of equipment. Maintains work areas in a clean, safe and organized manner.
- Performs similar or related duties as assigned or requested.
KNOWLEDGE, SKILLS AND ABILITIES:
Individuals must possess the knowledge, skills and abilities listed, or be able to explain and demonstrate the essential functions of the job. With or without reasonable accommodation, using some other combination of skills and abilities to possess the necessary physical requirements. Aid of mechanical devices to safely perform the essential functions of the job:
1. Physical requirements include the ability to extend hand(s) and arm(s) in any direction; raise objects from a lower to a higher position or move objects horizontally from position to position; pick, pinch, type or otherwise work with fingers rather than the whole hand or arm.
2. Ability to express or exchange ideas by means of the spoken word. Ability to convey detailed or important spoken instructions and to illicit information from patients, physicians, and other employees.
3. Ability to receive detailed information through oral communication and make fine discriminations in sound.
4. Ability to perform routine or repetitive duties working from detailed instructions and under standard procedures. Requires the making of minor decisions.
5. Ability to endure periods of heavy workload or stress.
6. Ability to work with frequent interruptions and respond appropriately to unexpected situations.
7. Ability to interact with irate customers.
8. Ability to interact with physicians and staff and participate as a team member with individuals inside and outside the department.
9. Visual acuity sufficient for work which deals largely with preparing data and figures, accounting, transcription, computer terminal operation, extensive reading and visual inspection of small parts/devices.
10. Ability to have general computer knowledge and skills; ability to perform basic math; working knowledge of ICD-10 and CPT coding and insurance procedures.
11. Ability to exert up to 10 pounds of force frequently and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.
12. Individuals are required to refrain from participating in any activities that could be construed as fraud and abuse. Requires the ability to follow Catholic Medical Center's Standards of Business Conduct in any instance where you feel there is suspicion of fraud or abuse, or a violation of the law. Requires that suspicion or knowledge of any person's violation of the Code be reported to the Corporate Compliance Officer. The extent to which you comply with the requirements contained within the Code will be a factor in evaluating your overall job performance.
OSHA RATING: Category II (No exposure to blood borne pathogens)
PHI ACCESS: Complete
WORK SCHEDULE:
Generally, Monday through Friday, days.
QUALIFICATIONS:
Education:
• High school diploma or equivalent.
Experience:
• Two to three years' experience in health care setting performing similar work activities including, but not limited to scheduling procedures and prior authorization knowledge.
