Surgery Coordinator - FT - Days - DHR Vein Institute

Position Summary

This position will determine insurance eligibility, financial status and eligibility for registration by reviewing insurance information via phone or online verification, calling third‑party payers to obtain insurance benefits which include the effective dates of coverage, billing address, pre‑existing condition clauses, in and out of network benefits and maximum coverage. Such duties include but are not limited to: meeting with the patient and explaining their surgery orders and pre‑surgical testing needed, scheduling in‑office and in‑hospital procedures, ensuring necessary authorizations have been obtained, entering data into the facility computer system, and participating in the development of new diagnostic testing or programs.

• High School graduate or G.E.D. certificate preferred
• Completion of CNA program, Medical Office Specialist, or comparable program preferred

• Two (2) years continuous experience in a busy healthcare office with at least one (1) year insurance verification experience (required); previous surgical scheduling experience is preferred.
• Prefer previous physician office or hospital experience
• Must have Excel and Microsoft suite computer experience and be able to learn the department IS system
• Must have excellent customer service skills
• Medical Terminology, ICD Codes, CPT Codes, HCPCS codes, and Modifier knowledge preferred
• Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, and spell correctly
• Requires reasoning ability and good independent judgment
• Requires working with frequent interruptions
• Must project a professional image
• Must be sensitive to cultural and bilingual issues
• Excellent organizational skills are necessary
• Good written and verbal communication skills required
• Ability to read, write and speak English
• Good understanding of insurance benefits, surgical orders and medical terminology
• Ability to communicate clearly and concisely with all levels of nursing, administration, patients and physicians

• Promotes the facility mission, vision and values by effectively communicating them to others and considering them in developing services, standards and practices
• Schedules surgeries for both in‑hospital and in‑office procedures
• Obtains authorization or pre‑certification as needed
• Schedules, coordinates and monitors appointments of patients for pre‑surgical diagnostic testing and registration
• Forwards a completed copy of the schedule with applicable patient benefits to front desk staff and/or MD for collection of applicable deductible and co‑pay amounts
• Confirms billing address, pre‑existing conditions, in and out of network benefits and maximum coverage
• Reviews and confirms patients' financial information by obtaining the insurance carrier information, benefit information, policy number, group name, group number, and the effective date of coverage
• References ICD‑9‑CM/ICD‑10‑CM, CPT from doctor’s order to insurance carrier for eligibility and coverage of procedure
• Reviews and confirms patients' deductibles, co‑pays, and co‑insurance with insurance carrier
• Identifies the appropriate coordination of benefits for insurance carriers
• Utilizes phone or online verification systems such as TMHP, Availity, Data Link, internal system, etc. for insurance eligibility and benefits
• Determines financial status, meets with patient and refers patient for financial screening as appropriate
• Ensures referral/pre‑authorization/pre‑certification requirements have been met
• Reviews physician order for appropriate patient status (Inpatient/Outpatient) before verifying coverage for procedure
• Documents clearly and concisely all patient benefit information on accounts through the computer system
• Screens and follows up on patient test results as required
• Maintains appropriate follow‑up and contact with hospital or patient if necessary
• When working at the reception desk, checks patients both in and out of the practice, properly documenting registration in the computer as needed
• Ensures patient confidentiality requirements are met in accordance with HIPAA/PHI policies and procedures
• Adheres to managed care…