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Job Summary:

This position is responsible for accurately performing Concierge functions, including scheduling, posting of surgical cases, pre-registration, insurance verification, and pre-certification.

Essential Functions & Responsibilities: 

Performs accurately and timely scheduling of assigned procedures in accordance with applicable department specifications and physician script order. Schedules surgical case(s), obtains required data elements, and identifies special equipment/ instrumentation, and preferences.Schedules/pre-registers appropriate pre-admission testing services; expedites services from other departments.Obtains the information necessary to provide financial clearance and successfully secures accounts for services in a timely manner by utilizing on-line resources, websites, telephone, etc. Provides price quotes and estimates.Interviews patients and follows up with patients who cancel procedure appointments or are no-shows.Collects diagnosis information and CPT/HCPCS codes from physician’s offices at the time of scheduling to aid in insurance verification and pre-authorization/certification process. Refers concerns/problems in scheduling cases to Specialty Coordinator, Resource Team, then to Administrative Manager/Supervisor as needed.Assists physician practice with re-arranging the schedule as directed and notifies appropriate parties. Coordinates peer to peer reviews as needed between the physician and the insurance company.Provides and maintains clinical documentation necessary for securing insurance authorization. Monitors reports in accordance with insurance verification and authorization procedures. Processes insurance verifications through various systems and websites.Performs all aspects of the insurance verification process for Medicare, Medicaid, and commercial insurance payers to ensure compliance and appropriate assignment for the coordination of benefits.Obtains authorizations from insurance companies/physician offices. Certifies that the authorization has not expired, complete and accurate information is entered into the patient accounting system, the procedure scheduled, and the date of service and facility name are consistent with the authorization.Collaborates with internal Associates and departments to financially secure the encounter. Prepares and communicates patient waivers/Advanced Beneficiary Notifications for encounters that are not financially secure to the department or area of responsibility.Assists with communicating patient/guarantor financial responsibility, co-pay, deductible and/or self-pay deposits.Communicates the status of a referral, pre-authorization, network benefits, out of network benefits, and patient waivers. Communicates operational activities, issues, and audit findings with appropriate leadership on a regular and timely basis. Identifies and recommends process improvements for the surgical practice.Maintains documentation necessary for compliance with state, federal and other regulatory agency requirements.Performs other duties as assigned.

Qualifications:

High school diploma or equivalent GED required.A minimum of two years’ experience in patient scheduling, registration or healthcare billing required.Experience in data entry, customer service, collections and medical terminology preferred.Proficiency with electronic medical record software applications, computers, telephones, fax machines, and the use of various software applications required. Familiarity with Mary Washington Healthcare’s IT systems preferred.Strong verbal, including telephone etiquette, and written communications skills required.Ability to prioritize and perform work in an organized, efficient and effective manner without on-site supervision and direction is required.Bilingual (Spanish) skills a plus.

As an EOE/AA employer, the organization will not discriminate in its employment practices due to an applicant's race, color, religion, sex, sexual orientation, gender identity, national origin, and veteran or disability status.