POSITION DESCRIPTION

POSITION SUMMARY: Receives physician and patient phone calls or faxes to schedule patients for services with Potomac Valley Hospital Physician Practices. Manages the registration process to ensure the financial viability. Responsible for accurate and timely interviewing of patients and/or relatives in a courteous manner to obtain registration data based upon comprehensive data elements to complete the registration process. Communicates with physician offices concerning clinical information. Communicates and supports hospital departments using scheduling system. Schedules multiple services in correct clinical sequence. Ensures that all state/federal regulations are met. Initiates and coordinates the information necessary for prompt and efficient admission, transfer, or discharge of patients in compliance with state and federal regulations.

MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1.

High School diploma or equivalent.

EXPERIENCE:

1.

Three (3) years’ experience in a physician/hospital scheduling and registration (including obtaining prior authorizations, admissions, and insurance verifications) or business office environment.

PREFERRED QUALIFICATIONS:

EXPERIENCE:

1.

Five (5) years’ experience in a physician/hospital scheduling and registration (including obtaining prior authorizations, admissions, and insurance verifications) or business office environment.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1.

Schedules outpatient procedures via telephone with patients and offices in a courteous, professional manner.

2.

Coordinates multiple procedures patients have to ensure they are scheduled on the same day and within an appropriate time frame.

3.

Provides patients and offices with accurate instructions regarding the scheduling procedure (i.e.: NPO, arrival time, where to arrive, etc.)

4.

Checks order documents for completeness. Validates orders against schedule services.

5.

Clearly documents activities and actions taken on accounts – including, but not limited to, authorization, communication with patients, staff, and other departments.

6.

Maintains scheduling and registration accuracy threshold of 95% as identified in audit processing.

7.

Performs prior authorization process by performing medical review and entering authorizations into the system.

8.

Works and assists with the billing department in researching and resolving rejected, incorrectly paid, and denied claims as requested.

9.

Obtains demographic/billing/insurance information from patient/family/legal guardian and correctly enters into the scheduling and registration/billing systems for service and claim processing.

10.

Verifies insurance, validates pre-cert/pre-auth information after completing of insurance verification and records results in system. Performs other insurance related functions as required or necessary.

11.

Completes Medicare Secondary Payer forms, where applicable. Completes medical necessity screening. Verifies medical necessity for applicable payer and service.

12.

Cancels or reschedules patients in accordance with hospital workflows.

13.

Exercises proper stewardship through the appropriate use of supplies, equipment, and time.

14.

Follows hospital, state, and federal guidelines for ensuring safe environment for workers, patients, and public. Ensures compliance by staff to hospital, governmental, and insurance regulations.

15.

Actively participates in in-services, staff meetings, continuing education courses, hospital wide committees, and other meetings as needed or required.

16.

Participates in the processes to assess and improve the services provided and compliance with regulatory requirements. Reports results assessment and improvement processes to the appropriate administrative level.

17.

Answers telephones and transcribe messages.

18.

Communicates verbally, written, and electronically with healthcare personnel, families, and patients.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.

Must meet Department of Labor’s MEDIUM duty standard (MEDIUM WORK – exerting up to 50 pounds of force occasionally, and/or up to 20 pounds of force frequently, and/or up to 10 pounds of force constantly).

2.

Able to bend, stoop, reach and be capable of normal rotation, standing and walking for an 8-10 hour shift.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1.

May be required to travel between facilities/buildings.

2.

May be scheduled to work various shifts based on departmental and patient needs.

SKILLS AND ABILITIES:

1.

Strong communication skills.

2.

Excellent customer service and telephone etiquette.

3.

Use a computer keyboard, monitor, and mouse.

4.

Knowledge in admissions, registration, and insurance verification.

5.

Working knowledge of office equipment and computers.

6.

Must demonstrate the ability to use tact and diplomacy in dealing with others.

7.

Knowledge of healthcare insurance plans.

8.

Knowledge of hospital clinical departments and service protocols.

9.

Knowledge of hospital payment plan guideline.

10.

Knowledge of healthcare coding practices. Understands and uses applicable CPT and ICD-9 codes.

11.

Ability to multi task and perform duties well, while under pressure, while meeting deadlines.

Date Reviewed/Revised: March 2019