Precertification Specialist / Scheduler (Glenwood Springs Office)

This is a 40/hr per week, full-time position with full benefits. Mon-Friday, days.
To assist in scheduling patient encounters for all clinical service departments using Meditech Scheduling and B/AR module. To act as liaison between Hospital departments to effectively coordinate scheduling of tests and procedures. Responsible for pre-authorization function to assure accurate and timely payor information and fiscal responsibility. ESSENTIAL JOB DUTIES Accurately schedules appointments, choosing appropriate appointment types, and correct data entry. Professional & responsive communication with physicians, patients, and departments. Mammo - interviews & schedules patients using: symptoms/screening, Insurance/Komen or other Grants, implants, & requests for previous films. Assist Breast Liaison with follow-up. Keeps current on all grant criteria & requirements. Produces day end reports & distributes. Includes reviewing scanned orders, correct procedure vs. actual order, and ABN if needed has been processed & distributed accordingly. Works with other PFS staff to ensure fiscal management of appointments. Stays current on Medicare & insurance requirements, ensuring ABN's & insurance waivers & pre-certs
are completed & communicated to patient & scanned. Understands and complies with all Hospital, patient confidentiality, ABN’s and insurance waivers. Participates in trainings & staff meetings. Reads daily summary reports & emails to be aware of changes. Fiscal responsibility including reviewing and completing ABN’s, Insurance authorizations/waivers, and ensuring completed precertification as needed. Schedules and pre-certifies all Physical Therapy patients-at all AVH locations. Reviews and monitors CAP requirements and ABN’s for Medicare patients. Pre-certify and/or check for MCR ABN on all patients with scheduled lab tests-at all AVH locations. As above does all pre-certification, insurance authorizations and waivers, required ABN’s and CAPS. SERVICE EXCELLENCE/CUSTOMER SERVICE Demonstrates purposeful service excellence through exceeding patient and coworker expectations. Represents the department/hospital as a dedicated, courteous, and responsive employee COMPLIANCE WITH RULES, REGULATIONS AND POLICIES Records pertinent documentation in accordance with regulatory requirements, professional standards and hospital policy. Adheres to federal, state and hospital rules and regulations concerning HIPAA privacy and security. Follows Hospital compliance plan and policies, including the Code of Conduct. Participates in required training for compliance related activities (HIPAA, Compliance, Patient Safety, TJC, etc.) UNIT SPECIFIC DUTIES & RESPONSIBILITIES / DAY TO DAY OPERATIONS Utilizes computerized scheduling and B/AR modules to maximize benefit for AVH and customers. Adapts software to meet needs. Provides assistance to other departments as needed. PROFESSIONALISM Demonstrates responsibility and accountability for own professional decision making and professional growth. Participates and contributes to departmental meetings and activities. POPULATION SPECIFIC CRITERIA Demonstrates the ability to assess and interact with customers of all ages, recognizing language and learning barriers, and technology challenges. Able to state his/her duties during a code pink drill. CORE VALUES Teamwork:works collaboratively with physicians and other staff and assists whenever possible. He/she openly shares information, provides feedback and participates in appropriate decision making as part of a team of healthcare professionals. Hospital and departmental objectives are placed ahead of individual agendas Respect for Others:actively listens to others, takes other opinions into account, and communicates openly and honestly. He/she demonstrates respect for others by being timely with communications, completion of tasks, and meeting attendance. The employee is respectful of all physicians, colleagues, patients, visitors, and other stakeholders Accountability:takes responsibility for his/her actions, abides by the hospital's guiding philosophies and policies, and follows through on commitments and physician orders. He/she provides complete and accurate information to the Physician and/or other members of the work team. takes personal pride and ownership in the quality of care and services provided to all internal and external customers Integrity:is truthful, trustworthy, and principled. He/she demonstrates character, conviction, and honest and ethical behavior in all interactions with others. The employee's word can be trusted. Behavior is consistent with these AVH Core Values