Under limited supervision, schedule procedures and obtain pre-certification for various medical and surgical services performed within a MFA department or division. Guides surgery patients through the program from initial contact to surgery and beyond which includes registration, scheduling patients, pre-authorization and charge submission. Requires stellar communication and customer service skills. Knowledgeable in all participating third party carrier policies and procedures regarding pre-certification.
Essential Duties and Responsibilities include the following. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Other duties may be assigned.
Schedule and post various procedures within the department
Contacts third party carriers verify insurance benefits and obtains pre-authorization for all procedures
Generate insurance referrals as directed by the medical provider
Assist medical provider with patient care information applicable to scheduled service
Acts as a contact for patient, for rescheduled procedures and cancellations
Acts a liaison between the MFA and other outside medical entities such as hospitals.
Create and maintain the call schedule for the physician with outside entities such as hospitals
Acts as an expert resource for insurance benefit related issues within the department
Maintains spreadsheets with detailed pre-certification data for tracking &reporting purposes
Comprehends clinical data with knowledge of procedure & diagnosis coding
Comprehends third party carrier claim adjudication process
Prepare and mail appointment confirmation letter. Inform patient requirements for appointment/procedure.
Acts as liaison between MFA and other ancillary and outside departments as it relates to patient referrals and scheduling of test and procedures.
Comprehends clinical data with knowledge of procedure & diagnosis coding.
Touch Works scanning of documents on a daily basis.
Tasking to assist with provider and patient administrative requests.
Assist patient with follow-up needs in a professional, systematic and organized manner.
Maintains insurance matrix & procedure code matrix to assist with scheduling & referral responsibilities
Cross train to provide backup in other administrative areas.
Perform additional duties as assigned.
The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
GW Medical Faculty Associates