Insurance & Surgery Coordinator

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Central Maine Healthcare
Published
June 7, 2021
Location
Lewiston, Maine
Job Type

Description

  • Insurance & Surgery Coordinator

    • 10 High Street Building
  • At Central Maine Healthcare our team members are committed to providing exceptional care and experiences for our community and for each other every day.

    Position Summary: The Insurance & Scheduler Coordinator provides support administrative assistance in the areas of surgical scheduling, preauthorization for testing and procedures for bariatric surgery, and referrals to consultants and for testing. Performs insurance verifications for scheduled patients for bariatrics consultations, post-op follow ups appointments, non-surgical weight loss consultations and follow up appointments. The work is done in an effort to ensure an optimal patient surgical experience, cost-effective measures of operation, maximum reimbursement, optimal lines of communication, and promotes effective management of various areas of responsibility. Records statistics as requested. Performs all secretarial and reception duties as requested.

    Duties and Responsibilities:
    Demonstrates Competency in the Following Areas:
    1. It is the responsibility of the surgical scheduler to schedule and be responsible for all surgeries including necessary paperwork. This will include but is not limited to surgeon’s schedules, insurance pre-certs/referrals, arranging surgical testing and arranging patient’s surgery and patient follow-up appointments.
    2. Communicates with physician groups pro-actively to resolve booking conflicts and to promote appropriate utilization of time.
    3. Completes referrals for patient testing or consultation from specialists. Makes appointment for patient and ensures proper communication to all involved parties.
    4. Processes prior authorizations for all surgeries and any testing that requires authorization. Documents results where necessary.
    5. Registers and schedules patient for routine follow-up, PAT and all surgical appointments.
    6. Establishes and maintains excel tracking spreadsheet for patient program progression and insurance communication.
    7. Answers phone within three rings in a courteous manner. Records/distributes an accurate message in a timely manner.
    8. Utilizes initiative; strives to maintain steady level of productivity; self-motivated.
    9. Organization and management of scheduler’s activities reflects due consideration for the needs of the department and staff.
    10. Reviews patient’s H&P to determine if the patient meets criteria to utilize their bariatric insurance benefits.
    11. Maintains current knowledge of insurance pre-certification requirements and benefit information. Meets all deadlines and requirements as set forth by the health plans, the department and the hospital.
    12. Verifies new patient insurance benefits according to appointment notes.
    13. Verifies follow up patients insurance benefits that have not been verified for the current year (plan year or calendar year)
    14. Checks for secondary insurance policy and urforms verification.
    15. Follows up with precept status and faxes medical records to insurance company for precept approval.
    16. Contacts patient if insurance is terminated, a coordination of benefits is required, or if the policy information on file is incorrect.
    17. Provides regular updates and communication to patients regarding case statues, submission, approval or denial, and appeal process.
    18. Processes appeals and schedules peer to peer phone appointments with the surgeon for denied cases.
    19. Reviews appointment schedule for add-on appointments that require verification.
    20. Takes initiative to resolve reimbursement issues in a timely manner, involving all necessary parties in the process.
    21. Processes referrals to other services when needed.
    22. Records and reports monthly case volume in excel format.
    23. Demonstrates flexibility within department. Will cover front office responsibilities when needed.
    24. Customer Service: Interacts with all individuals in a consistent manner, providing attention, support, and assistance to foster an environment of exceptional personal service.
    a. Maintains a pleasant and helpful demeanor, and presents a professional appearance toward all internal and external customers at all times.
    b. Consistently initiates interaction to provide assistance to individuals who may not be direct customers of the employee (i.e. asks patients who appear to be lost if they need assistance in finding their way).
    c. Takes appropriate action to recover from a service difficulty, ensuring that the necessary action is taken to affect a resolution to the customer’s problem.
    d. Conducts all work activities with respect for coworkers, including the maintenance of a pleasant and professional environment, fostering calmness during stressful situations.
    e. Interacts with supervisory personnel in a professional, supportive and courteous manner, venting emotions appropriate to time and place.
    f. Demonstrates a commitment to service by consistent attendance and punctuality, scheduling absences according to departmental requirements, and incurring unplanned absences only when unavoidable circumstances exist.

    Organizational Requirements:
    1. Adheres to dress code, appearance is neat and clean.
    2. Completes annual education requirements.
    3. Maintains regulatory requirements.
    4. Reports to work on time and as scheduled, completes work within designated time.
    5. Wears identification while on duty, uses computerized punch time system correctly.
    6. Completes inservices and returns in a timely fashion.
    7. Attends annual review and department inservices, as scheduled.
    8. Attends at monthly staff meetings, reads and returns all monthly staff meeting minutes.
    9. Represents the organization in a positive and professional manner.
    10. Actively participates in performance improvement and continuous quality improvement (CQI) activities.
    11. Complies with all organizational policies regarding ethical business practices.
    12. Communicates the mission, ethics and goals of the facility, as well as the focus statement of the department.
    13. Confidentiality: Maintains confidentiality of information at all times.
    a. Consistently maintains confidentiality of all information gained during the course of employment, respecting the privacy of others.
    b. Understands and maintains the confidentiality of information communicated directly from the supervisor, including discussions of a counseling nature.
    c. Follows policies and procedures related to medico legal matters, including confidentiality, amendments of medical records, patient rights, medical records as legal evidence and informed consent
    d. Copies records according to policy, assuring the appropriateness of the individual requesting information from the record prior to copying, faxing, or phoning any portion of the record.
    14. Safety: Demonstrates an understanding of fire and electrical safety, infection control, body mechanics, and related areas, as appropriate to position.
    a. Attends mandatory in-services on fire safety, electrical safety, infection control, and body mechanics. Successfully completes competency-based training in each area.
    b. Follows all employee health procedures, incident reporting, and infection control requirements at all times, as appropriate to the position.
    c. Uses proper body mechanics at all times as required by the physical demands of the position.
    d. Maintains a safe work environment and performs duties of the position in a manner consistent with ensuring the safety of self and others.
    e. Identifies safety needs in areas outside own work environment, recommending corrective action as appropriate.
    15. Expense Control: Performs job duties in a manner that maximizes expense control.
    a. Uses supplies, equipment, and utilities in an expeditious manner
    b. Consistently recommends methods to control costs while maintaining a high degree of customer service.
    c. Performs job tasks efficiently and effectively resulting in no unplanned overtime.

    Regulatory Requirements:
    • High School graduate or equivalent.
    • Minimum of two years relevant experience, including knowledge of scheduling, registration, patient billing, and medical terminology.
    • Minimum of one (1) year experience as surgery scheduler preferred.
    • Understanding of various insurance plan requirements & authorization processes: government agencies, Medicare and Medicaid and commercial insurance.
    • Knowledge of appeals and denial coordination in collaboration with clinical team.

    Language Skills:
    • Able to effectively communicate in English, both verbally and in writing.
    • Additional languages preferred
    • Experience with multifaceted conversation

    Skills:
    • Must demonstrate the ability to use variety of software programs, basic computer knowledge, and data entry
    • Ability to type minimum of 40 wpm.
    • Knowledgeable in skills of patient/guest relations.
    • Must be detail oriented with exceptional organizations skills.

    Physical Demands:
    • For physical demands of position, including vision, hearing, repetitive motion and environment, see following description.
    Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising client care.

    If you are passionate about making a difference and are looking for your next great career opportunity, we look forward to reviewing your application!

      Posted 3 Days Ago
      Full time
      29727

About Us

  • AT CENTRAL MAINE HEALTHCARE YOU ARE AT THE CENTER OF EVERYTHING WE DO

    Our why, our purpose, drives every decision and action we take as a healthcare system. We strive everyday to deliver exceptional care, and to improve our community.  We are a non-profit organization that is breaking the traditional healthcare mold by bringing our patients and their family’s high value, low cost, and award-winning care while focusing on creating an exceptional experience for them; all within their communities.  To accomplish this, we only hire individuals who are committed to excellence, who embody the principles of our CMH Experience Service Standards, and who are ready to step in and help their fellow team members achieve those exceptional results for our patients, their families, and the community.

    Central Maine Healthcare System

    The organization is broad in its footprint, with three (3) hospitals in Bridgton, Lewiston, and Rumford, and over 75 individual practices within our Medical Group.  Lewiston’s Central Maine Medical Center is a certified and award-winning level two trauma center, along with our Central Maine Heart and Vascular Institute and the upcoming highly anticipated launch of our comprehensive state of the art cancer treatment center. Both Bridgton and Rumford Hospitals are four (4) star accredited acute care hospitals, and our Medical Group and Maine Urgent Care Centers have won multiple awards within their specialties.  As a system we are a six-time winner of the Leapfrog Safety A Rating since 2019, representing some of the highest quality care and outcomes nationwide. Our awards and accolades are only possible as a result of our commitment to culture, and a focus on safety and inclusion, in each of our patient’s experiences and in the experiences we create within our teams.

    If you are a person who is looking for a way to give back to your community, to help improve the lives of patients or those who care for our patients, want to be part of a growing organization that is setting the bar for Maine healthcare, apply to join Central Maine Healthcare today!

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