Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.
Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates.
The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time).
Pay Range:
$21.76 - $28.28Scheduled Weekly Hours:
40Position Overview
Ensures and completes authorization processes and chart review functions for outpatient testing services prior to services being rendered to ensure timely patient care and maximum reimbursement by payor. Performs tasks of position successfully as they directly impact denials and reimbursement. Maintains complete knowledge of the pre-registration/scheduling system and department operational procedures and training guidelines to identify and audit charts for accurate demographic, diagnosis, and insurance information for all scheduled tests.
MINIMUM REQUIREMENTS
Education: High school diploma or equivalent.
Experience: Three years' experience in patient scheduling or in a medical office role working with patient insurance. Experience in insurance verification and authorization preferred.
Other Credentials:
Knowledge and Skills: Working knowledge of medical insurance plans. Proficiency in working with payers' on-line portals, as well as other external resources preferred. Advanced knowledge of medical terminology, diagnosis and CPT codes preferred. Possesses strong skills in patient relations, pre-registration, scheduling, pre-certification, and reviewing of all scheduled outpatient accounts.
Special Training: Strong attention to detail. Ability to multi-task and navigate between systems simultaneously. Ability to handle a large volume of charts. Manages time and works well in a fast-paced environment
Mental, Behavioral and Emotional Abilities: Ability to deal with problems involving several known variables in situations of a routine nature. Ability to effectively communicate information and respond to questions in person-to-person and small group situations with customers, clients, general public and other employees of the organization.
Usual Work Day: 8 Hours
Reporting Relationships
Does this position formally supervise employees? No
If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.
ESSENTIAL FUNCTIONS
Uses knowledge and skills of pre-registration scheduling requirements and applies them during chart review. Reviews all required information to ensure chart is complete.
Performs chart review to identify if variation from quality registrations exists. Determines the need for process improvement. Identifies concerns and makes recommendations for review to improve processes.
Communicates findings as appropriate to department management involved. Reports discrepancies to supervisor or manager to ensure corrective action is taken in a timely manner.
Maintains complete knowledge of pre-registration/scheduling system and department operational procedures and training guidelines to identify and review charts for accurate demographic, diagnosis, and insurance information for all scheduled tests.
Secures insurance authorizations and pre-certifications for outpatient services. Verifies pre-certification to ensure appropriate reimbursement.
Maintains proper communication skills with physician offices to obtain needed information for authorizations. Obtains and reviews physician orders for medically necessity coverage requirements.
Assists with development and implementation of new or improved processes. Maintains up to date knowledge with Insurance guidelines, pre-registration and scheduling compliance, insurance applications, and other systems utilized by Scheduling.
Participates in training of new hires and re-education process for existing employees.
Possesses proficiency with all insurance plans and payor codes. Identifies payment source and secures all information required to insure a billable and collectable account and avoid penalties or denials prior to the bill dropping.
Maintains thorough understanding of payor requirements for authorization, pre-authorization, and referrals. Performs verification of benefits either electronically or by telephone according to department procedures and guidelines.
Identifies and obtains required precertification, authorizations and referrals and reviews all information in the appropriate scheduling and billing system.
Possesses ability to understand and use audit reports for missing vital billing information. Reviews coordination of benefits and Medicare secondary payor guidelines to determine primary and secondary payer status.
Maintains knowledge and is proficient with imaging software; Vitalware, all insurance applications as well as other external resources utilized for eligibility verification, authorization look up and/or precertification efforts. EMR pre-registration functions, and other systems utilized by Scheduling/Pre-certification functions.
Provides ongoing performance feedback, addresses problems discovered during chart reviews. Verifies and documents competency and identifies and suggests ways to develop skills.
Communicates new insurance rules, changes in policies, procedures and regulations as needed. Contacts patients prior to scheduled visit with inactive insurance coverage to obtain updated insurance information.
Works closely with other hospital staff, providers, and patients to resolve any issues with missing or incomplete authorizations and pre-registration to provide a smooth process.
Performs any other related duties as required or assigned.
PHYSICAL DEMANDS AND WORK ENVIRONMENT
Frequent physical demands include: Sitting , Standing , Walking , Keyboard use/repetitive motion
Occasional physical demands include:
Continuous physical demands include:
Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 10 lbs.
Sensory Requirements include: Very Accurate 20/40, Near Vision, Accurate Far Vision, Minimal Color Discrimination, Minimal Depth Perception, Accurate Hearing
Anticipated Occupational Exposure Risks Include the following: N/A
This position is eligible for the following benefits:
Medical Plan
Prescription drug coverage & In-House Employee Pharmacy
Dental Plan
Vision Plan
Flexible Spending Account (FSA)
- Healthcare FSA
- Dependent Care FSA
Retirement Savings and Investment Plan
Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
Disability Benefits – Long Term Disability (LTD)
Disability Benefits – Short Term Disability (STD)
Employee Assistance Program
Commuter Transit
Commuter Parking
Supplemental Life Insurance
- Voluntary Life Spouse
- Voluntary Life Employee
- Voluntary Life Child
Voluntary Legal Services
Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
Voluntary Identity Theft Insurance
Voluntary Pet Insurance
Paid Time-Off Program
The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level.
The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.