136-INSURANCE and SCHEDULING SPL

What You Will Do:

POSITION SUMMARY Responsible for the completion and coordination of all front-end activities associated with patient financial processing and scheduling at UMCRH Surgery Center. Priorities and coordinates patient accounts from patient scheduling through patient discharge to ensure that the patient financial obligations are met prior to outpatient surgery. Performs process quality assurance and continues process improvement activities. Further the incumbent maintains excellent working relationships with community providers and their staff.
This position description indicates in general the nature and levels of work, knowledge, skills, abilities and other essential functions expected of an incumbent. It is not an exhaustive comprehensive listing of activities, duties or responsibilities required of an incumbent. An incumbent may be asked to perform other duties as required. PRIMARY RESPONSIBILITIES
Principal Duties:
I. Insurance Verification & Financial Processing:
1. Verifies third party coverage for admissions, outpatient and same-day surgery services provided by UMCRH Systems facilities.
2. Calculates and estimates patient charges and calculates the deposit requirement based on total estimated charges and the patient’s insurance benefits according to departmental procedures if coverage is less than 100%.
3. Provides in-service guidance to other staff members to ensure departmental knowledge of insurance changes and requirements.
4. Documents patient’s insurance benefits and deposit requirements in the appropriate areas within the computer system.
5. Facilitates operation of financial screening processes.
6. Contacts insurance companies or other third party payers to verify insurance coverage, including exclusions as they may apply and the required authorization/pre-certification assignments.
7. Ensures insurance authorization and pre-certifications are documented appropriately in the computer system.
8. Communicates via phone and follow-up letter insurance limits and co-payments responsibilities to patients and/or guarantor.
9. Ensures the appropriate financial class has been assigned to the patient’s record in the computer
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PRIMARY RESPONSIBILITIES
system.
10. Develops a comprehensive understanding of reimbursement levels for the top third-party payers utilized by UMCRH Surgery Center and maintains current knowledge of insurance requirements.
11. Utilizing reports generated from the computer, calculate and estimate patient charges for the patient and/or guarantor. Communicate payment responsibilities and develop an appropriate payment plan to assist the patient.
12. Works with the department to establish pre-registration and patient check-in policies and procedures.
13. Develops a comprehensive understanding of authorization and contractual requirements for third-party payers utilized by UMCRH Surgery Center.
14. Records the following information in the appropriate areas in the computer system:
i. Deductible Amount/Amount Remaining
ii. Coverage Rate
iii. Maximum Coverage (Lifetime Max)/Amount Remaining
iv. Days Covered
v. Miscellaneous Coverage
vi. Patient’s Previous Bad Debt History
vii. Deposit Requirements
viii. Other Financial Data as Appropriate
15. Communicates insurance limits and other restrictions to other departments within UMCRH Healthcare System – i.e. Patient Accounting, Case Management.
16. Refers problem accounts due to lack of coverage or payment ability to the supervisor/director for review and possible postponement or cancellation.
17. Reviews all self-pay and manage care admissions to ensure that appropriate payment arrangements and authorizations are made.
18. Facilitates communication between DSC and Physicians, PAS and other service providers
19. Completes daily, weekly and monthly reports as required.
20. Performs complete and accurate registration and admission functions to provide information, which maximize reimbursement, achieve collection ratios, meet account receivable (AR) goals, and provide timely and through information to all other providers and users of patient data.
21. Verifies insurance requirements, obtains and understands insurance benefits and collects non-covered fees.
22. Registers and pre-registers all patient types. Performs cash collection functions and performs patient processing functions as follows:
i. Outpatient Surgery Pre-registrations
ii. Up-front Payment Estimation and Collections
iii. DSC Payment Collections
iv. Insurance Verification
v. Patient Scheduling
23. Maintains high attention to detail by reviewing all the work for completeness and accuracy. Completes account related tasks to meet department accuracy standards for error-free work.
24. Ensures that financial protocols and requirements are met while providing services at UMCRH Surgery Center.
25. Minimizes 3rd party payer denials by verifying authorization of services.
II. Scheduling & Office Administration
1. Schedules surgical cases and coordinates all supporting scheduling activities.
2. Secure assistance as needed to maintain smooth patient flow.
3. Retrieves data input from physician office posting coordinators and accurately schedules information for surgical cases, endoscopy procedures, and special procedures.
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PRIMARY RESPONSIBILITIES
4. Consistently communicates and documents all scheduling changes and coordinates scheduling to maximize productivity.
5. Follows up on problems pertinent to scheduling with department manager, anesthesia, and physician’s office staff.
6. Ensures proper information is provided by office staff related to the patient’s demographics and insurance information.
7. Communicates with department manager to ensure availability of appropriate nursing and anesthesia coverage for surgery scheduled and provides copies and distributes schedules to other departments.
8. Ensures communication of special material needs to nursing supervisor or department manager.
9. Performs departmental administrative functions as required including;
i. Answers incoming telephone calls according to departmental telephone standards (See Telephone Standard Policy).
ii. Opens doors at the beginning of shift.
iii. Registers patients and makes sure all paperwork is signed and completed prior to patient being admitted to Preop.
iv. Copies driver license and insurance cards, checks face sheet and communication assessment form for errors and completion.
v. Process lab requisition and take specimens to the lab.
vi. Prepares patient records and break down after surgery.
vii. Documents daily cancellations.
viii. Assists with data collection and quality improvement activities as needed.
ix. Sorts and distributes mail
x. Generates and distributes end of the month reports
10. Other duties as assigned.
Customer Service:
1. Greets customers in courteous, friendly, respectful and professional manner at all times, including maintaining eye contact when appropriate.
2. Follows communication protocols to both internal and external customers, including introducing him/herself with job title and experience, asking open ended questions, such as “How may I be of help to you?” using the customer’s name as soon as it is learned.
3. Responds promptly and appropriately to customer questions/concerns/complaints and attempts immediate resolution.
4. Keeps customer’s information confidential, including public places such as elevators or the cafeteria.
5. Provides assistance and offers help immediately, including finding someone else to meet the request, if unable to do so him/herself. Introduce other staff to customers when a hand-off occurs and explain that the person will provide excellent service.
6. Demonstrates commitment to excellent service recovery when a customer’s expectations have not been met.
Commitment to

to Co-Workers:
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PRIMARY RESPONSIBILITIES
1. Offers assistance to colleagues and other departments when needed.
2. Takes responsibility for solving problems regardless of origin; completes assignments, and respects deadlines.
3. Resolves conflicts directly with colleagues and seeks assistance from others if the issue cannot be resolved. Refrains from criticism in public.
4. Mindful and respectful of others’ time and schedules. Attends meetings on time and communicates any absences.
5. Provides co-workers with a status report for continuity of workflow when planning to be out of the office, off the unit, or away from the department
Communication Etiquette:
1. Respectful, courteous and professional in all forms of communication and follows facility’s service communication protocol in all interactions.
2. Refrains from use of personal cell phone in patient care areas and keeps usage to a minimum at all other times while on duty.
3. Does not text or use e-mail during meetings (except for exigent or emergency situations).
4. Limits use of business cell phone during meetings (remain on vibrate and/or calls go to voicemail).
5. Makes every effort to answer telephone calls within three rings, introducing him/herself, department and title (if appropriate). Asks permission before placing the caller on hold or using the speakerphone. If caller is transferred, gives the caller the extension number of the person he or she is being transferred to. Offers further assistance to the caller upon completing the conversation.
6. Maintains an appropriate voicemail message and when away from the office has an out-of-office email message that is brief, current, and includes name an…

What You Need to Be Successful:

POSITION REQUIREMENTS:
Licensure/Certification/Registration
Required: N/A
Preferred:
Other:
Certifications: (Check all that apply) within 6 months of hire
Basic Life Support – Health Care Provider (BLS-HCP) Advanced Cardiac Life Support (ACLS)
Pediatric Advanced Life Support (PALS) Neonatal Resuscitation Program (NRP)
Nurse Forensic Examiner: Adult
Nurse Forensic Examiner: Pediatric (or eligible)
Education/Knowledge (see attached explanation sheet)
Attained Level: Formal Education Training Required: High School graduate or equivalent.
Preferred: Associates Degree
Completed Course Work/Program:
Applicable Experience
Experience (years): Required: 3-5 years Preferred: 5-7 Years
Required/Preferred Experience:
3-5 years of experience working in a fully cross-functional team in an Insurance/Scheduling Specialist role and is knowledgeable in:
 Outpatient Surgery and Special Procedure Registration and Pre-Registration
 Insurance Verification
 Benefits Explanation
 Patient Scheduling
 Up-Front Payment Estimation and Collections
 Cashiering
Technical/Clinical Skills
Microsoft Office Suite Skill Level (see attached explanation sheet)
Word: Intermediate Excel: Intermediate
PowerPoint: Intermediate
We are an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.