Surgical Scheduling

· Tracks, monitors, and manages surgery status between centralized surgery scheduling, central authorization team, and clinical care team/office.

· Communicates changes in OR schedule to necessary hospital and authorization team in conjunction with care team.

· Ensures all elements of OR boarding slip is completed and accurate. Adjusts as necessary.

Authorizations/Denials

· Serves as a single point of contact for denials, appeals, requests for more information, etc. from central authorization team and includes clinical team as needed for submission, updating patient on progress and resolution.

· Communicates and updates patient(s) on authorization status, denial or appeal information, and general surgery questions, or any other insurance and patient questions or concerns.

· Maintains up-to-date knowledge of payer prior authorization requirements, eligibility guidelines and documentation requirements.

· Ensure all patient information is updated and available for authorization and clinical teams including but not limited to: appropriate surgery CPT codes, inpatient or outpatient status, clinical information readily available in chart, and insurance eligibility updated or confirmed.

· Submits urgent and routine authorizations to insurance companies as designated or requested.

· Monitors and updates surgeries to be authorized at least 48 hours before ahead of time: calls insurance company for updates, communicates with central authorization team if needed, as well as include care team if authorization is not going to be back in time.

· Ensures highest level of hospital status and payment can be received including highest level of admission status and bundled CPT codes are submitted for authorization. (i.e. inpatient vs. outpatient, ambulatory, etc.)

· Communicates and organizes peer-to-peer requests for surgeon and care team as needed.

· Investigates insurance communication to ensure appropriate authorization status and reimbursement will be maximized.

· Works appropriate workques (denial, authorization, etc.) as assigned by leader to ensure appropriate insurance payment.

· Assists in researching and implementing new procedures & surgeries as requested by leadership and surgeon.

Customer Service

· Follows up and investigates insurance reimbursement or payment concerns for both patient and practice as necessary.

· Serves as a primary contact for patient in office with payment or reimbursement concerns.

· Practices effective communication in all interactions.

Teamwork

· Promotes teamwork by keeping others informed and working to accomplish team objectives and goals.

· Actively participates in department huddles and activities.

· Keeps abreast of insurances’ changing policies and constantly changing policies and constantly updates department personnel of future reimbursement and authorization edits.

Personal Development

· Attends additional training, performs research, e-learning, to stay current on best practices and new practice management technology and functionality as it becomes available.

· Performs other related duties as assigned.

Our Commitment to Diversity and Inclusion
 

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.