Scheduler & Pre-Access Rep - Sleep Center Clinic

Major Responsibilities:

Using AIDET, collects, analyzes and records accurate and compliant demographic and clinical information in the scheduling system. Meets or exceeds productivity standards.
Using approved identification standards, positively identifies the patient before accessing existing medical record numbers or creating new patient entries.

• Provides patients with site and appointment date and time options, scheduling per patient preference or first appointment at optimal site.
• Accurately enters all required patient demographic and clinical data in scheduling application.
• Checks receipt of faxed orders and reviews for accuracy. Documents record if new or revised written orders are needed on day of service.
• Schedules with proper test sequencing when multiple tests are ordered, ensures there are no clinical, equipment or physician conflicts.
• Engages in frequent communication with all departments to ensure scheduling openings are current and time blocks are administered as needed.
• Explains procedures and provides patients/customers with accurate preparation information prior to exam. Ensures understanding of pre-procedure clinical requirements.
• Provides directions for patients to follow on day of service and ensures understanding of where to park, where to check-in, when to arrive, etc.
• Maintains synchronicity between the scheduling and registration systems when rescheduling, canceling or editing accounts.
• Identifies and respond appropriately to callers' communication needs, secures interpreter to complete scheduling and documents record for future visit.

Accurately collects, records and analyzes all required demographic, insurance/financial and clinical data necessary to preregister/preadmit patients from all payer classes. Meets standards for productivity defined as 100% scheduled patients pre-registered prior to arrival.

• Scans (or ensures) printed orders into the patient’s account or validates the patient is to bring on the day of service.
• Completes the MSP (Medicare Secondary Payer Questionnaire) thoroughly. Uses appropriate insurance codes accounts when Medicare is deemed secondary to other insurance.
• Preforms an abbreviated screening of insurance benefits and attempts to fast pass pre-registered accounts when able.
• Records accounts notes and appropriately codes accounts for hand-off to financial clearance.
• Reviews physician orders and other documentation against Medicare payer coverage and medical necessity criteria; translates text into code and uses screening software to determine whether services being provided meet third-party requirements for payments. Sends electronic requests to physicians to obtain additional diagnoses on orders as needed.
• Identifies if authorization/prior approvals are required for scheduled services. Requests and documents as appropriate.
• Schedules patients without authorization at least three days out to allow sufficient time to financially clear account. Escalates accounts to appropriate persons if time frame is shortened and account needs higher priority.
• Pre-authorizes patient for services with insurance company.
• Collects and records accurate and thorough patient, guarantor, insured and insurance information when preregistering patient accounts.
• Pre-registers accounts using appropriate clinic and service codes; and establishes account parameters to ensure revenue is properly recorded and accurate bills are produced.

Performs revenue cycle activities that prevent payment denials, increase cash collections and assures appropriate financial disposition of account balances. Meets defined standards for quality. i.e., all components of the pre-reg process must be completed pre-service, including discussions with patients when necessary. Accounts should require minimal registrar intervention on the actual date of service.

• Verifies insurance eligibility, reviews and if applicable, notifies the patient’s primary, secondary and tertiary insurance companies of the scheduled service and obtains benefit information and service authorizations.
• Follows up any accident, injury, or third party liability diagnosis appropriately and documents coverage determinations.
• Reviews the pass/fail of…