Location/Department: Ortho - MMPC

Benefits Eligible - part time 64 hours per pay period

Job Summary:

Insuring accurate selection of the patient & their demographic, employment & insurance data. Timely scheduling of patients while allowing for proper resource utilization such as room, equipment, technologist, physician, etc. Ensuring correct diagnosis/coding on patient order while meeting medical necessity determinations for payment & determining any pre-certification requirements are obtained correctly & accurately prior to the testing.

Supervisory Responsibilities:  None

Duties/Responsibilities:

·         Determine 2 forms of identification for each patient prior to scheduling.

·         Update all demographic data, employment data & insurance data at the time of scheduling.

·         Provide patient care by rooming patients, assisting with procedures as needed, & completing chart assignments when working in the back office setting.

·         Insure valid physician order by date & diagnosis.

·         Work directly with office physician and staff

·         Perform clerical functions of answering phone calls & scheduling appointments

·         Communicate & coordinate with vendors

·         Provide patients with surgery packet & review educational material

·         Review perioperative requirements including pre-op labs & clearance, physical therapy, post-op appts, etc.

·         Rotate between front & back office, assisting with patient care as needed

·         Run medical necessity software against obtained data for allowance & compliance.

·         Determine pre-certification requirements & obtain accurate data from physician office.

·         Validate pre-certification data with insurance carrier to insure facility payment.

·         Coordination of surgery scheduling with the corresponding departments as applicable.

·         Maintains changes in testing protocols by working with department managers & staff.

·         Maintains scheduling changes for preventative maintenances (PM), equipment downtime.

·         Phones patients to remind them of scheduled appointments day prior to appointment.

·         Reviews all prep instructions & responds to patient concerns & questions.

·         Provides cost of test & expected out-of-pocket expense to patient.

·         Notifies physician office when contacted by Business Office of claim denial relating to medical necessity & pre-certification denials.

·         Develops appeal plan with physician office within 2 days of denial per carrier contract language.

Required Skills/Abilities:

• ·         Strong communication & customer service skills.
• ·         Able to multi-task, problem solve, & complete tasks in a timely manner.
• ·         Able to operate a computer & other basic office equipment.

Education and Experience:

• CMA certification required
• Minimum of 2 years relevant work experience required.
• Strong background in medical terminology preferred.

Physical Requirements:

• Work requires constant talking; frequent, sitting, manual dexterity & use of hands; occasional walking, standing, & reaching.    
• Occasionally may need to lift up to 25lbs.