Major Responsibilities:

Collects, analyzes and records accurate and compliant demographic and clinical information in the scheduling system. Meets or exceeds productivity standards.

1)Identifies and respond appropriately to callers' communication needs, secures interpreter to complete scheduling and documents record for future visit.

2)Using approved identification standards positively identifies the patient before accessing existing medical record numbers or creating new patient entries.

3)Provides patients with appointment date and time options, scheduling per patient preference or first appointment and follow-up appointments as directed by clinicians.

4)Accurately enters all required patient demographic and clinical data in scheduling application.

5)Checks receipt of faxed orders and reviews for accuracy. Documents in record if new or revised written orders are needed on day of service.

6)Schedules with proper test sequencing when multiple tests are ordered, ensures there are no clinical, equipment or physician conflicts.

7)Engages in frequent communication with all departments to ensure scheduling openings are current and time blocks are administered as needed.

8)Explains procedures and provides patients/customers with accurate preparation information prior to exam. Ensures understanding of pre-procedure clinical requirements.

9)Provides directions for patients to follow on day of service and ensures understanding of where to park, where to check-in, when to arrive, etc.

10)Maintains synchronicity between the scheduling and registration systems when rescheduling, canceling or editing accounts. Maintains accurate patient/physician scheduling system.

Accurately collects records and analyzes all required demographic, insurance/financial and clinical data necessary to pre-register/pre-admit patients from all payer classes. Meets standards for productivity defined as 100% scheduled patients pre-registered prior to arrival.

1)Collects and records accurate and thorough patient, guarantor, insured and insurance information when preregistering patient accounts.

2)Provides information for pre-registration of accounts using appropriate clinic and service codes; and establishes account parameters to ensure revenue is properly recorded and accurate bills are produced.

3)Obtains printed physician referral orders or validates the patient is to bring on the day of service.

4)Uses electronic systems to confirm coverage while patient is present and discussing the findings with the patient. Follow established department policies to resolve issues related to patient's eligibility for coverage or issues in in-network status for the patient using Advocate's network.

5)Reviews physician orders and other documentation against Medicare payer coverage and medical necessity criteria; to assess whether services being provided meet third-party requirements for payments. Sends electronic requests to physicians to obtain additional diagnoses on orders as needed.

6)Identifies if authorization/prior approvals are required for scheduled services. Requests and documents as appropriate. Ensures each accounts' financial clearance disposition is correct and easily identified for the date of service registrar.

 7)Schedules patients without authorization at least three days out to allow sufficient time to financially clear account. Escalates accounts to appropriate persons if time frame is shortened and account needs higher priority.

 8)When assisting walk-in patients, screen orders for compliance with policy. Work with physicians, Care Coordinators, and clinical department leaders to communicate and resolve issues related to order quality and acceptable standards.

Performs revenue cycle activities that prevent payment denials, increase cash collections and assures appropriate financial disposition of account balances. Meets defined standards for quality. i.e., all components of the pre-reg process must be completed pre-service, including discussions with patients when necessary. Accounts should require minimal registrar intervention on the actual date of service.

1)Verifies insurance eligibility, reviews and if applicable, notifies the patient’s primary, secondary and tertiary insurance companies of the scheduled service and obtains benefit information and service authorizations.

2)Review accounts for completeness and accuracy and updates account documentation/financial clearance disposition as needed.

3)Communicates with appropriate persons regarding all aspects of pre-registration, registration, verification, precertification and date of service / insurance issues.

4)Alerts Financial Counselors when presented with out of network plans, insurance denials, and high dollar deductible and out of pocket maximums.

5)Refers to supervisor any accounts that do not meet standards for financial clearance disposition.

6)Contacts the patient/representative, physician, insurance company or others if additional information is needed to financially clear patients on the date of service.

7)Completes departmental charge entry within one business day and performs daily charge reconciliation to assure accuracy of patient billing.

Support the overall functioning of the department’s operations.

1)Reviews reports to determine who needs reminder calls. Places reminder calls to pre-registered patients 24-48 hours prior to service date. Confirms service date/time/place with patients and reschedule services as needed.

2)Answer and direct incoming calls to the appropriate personnel.

3)Communicate pertinent information staff in a timely manner.

4)Perform assigned tasks as requested by the department manager.

5)Accept ownership and work with the team to provide accurate information and problem solving techniques to improve work processes that are within your department.

6)Adheres to hospital policy regarding maintenance and storage of medical records.

7)Demonstrate effective communication skills to establish and foster team relationships which promote outcomes that improve and enhance your department services.

8)Participates in inventory, ordering, and distribution of clerical and clinical supplies as directed.

9)Accepts and completes other duties and special projects as assigned.

Education/Experience Required:

HS diploma or equivalent.2-3 years related experience preferably in a healthcare setting (revenue cycle experience preferred), hospital, physician office or insurance company.Applicable education may be substituted.Knowledge of medical terminology is strongly preferred.

Knowledge, Skills & Abilities Required:

Effective organizational and prioritization skillsProficient in the use of Microsoft Office (Excel, Power Point, Access and word) or similar products, including maintaining, tracking, and entering data in a database and/or spreadsheet software.Exhibits sophisticated interviewing, communication and negotiation skills.Possesses intermediate math and business writing skillsKnowledge of office equipment Computer literateDemonstrated customer service skills.

Physical Requirements and Working Conditions:

Ability to work in a fast-paced environment with established time constraints and emotional and sensitive situations. Employee is regularly required to sit, stand, walk, talk and hear. Must possess visual acuity and manual dexterity to perform computer data entry and other clerical aspects of the job. May bend, stoop, twist and reach in conjunction with the job requirements. May lift files, reference books, supplies, and other documents up to 10 lbs. May walk and push a wheeled cart with a computer and supplies weighing up to 50 lbs. This is both a sedentary and active position. Employee is regularly exposed to noise associated with working around others in an office setting. May be exposed to a variety of illness and medical conditions. Must be able and willing to work weekends, holidays and occasionally other shifts. Must be able and willing to rotate work environments, ED, OP/ADM, Rover, Check-In, Phone Desk, etc. May need to work shifts at off-site locations.If position has direct patient care or direct patient contact the following lifting requirement supersedes any previous lifting requirement effective 06/01/2015. Ability to lift up to 35 pounds without assistance. For patient lifts of over 35 pounds, or when patient is unable to assist with the lift, patient handling equipment is expected to be used, with at least one other associate, when available. Unique patient lifting/movement situations will be assessed on a case-by-case basis.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.