Pt Access Scheduler Lead

SUMMARY:

Assists manager with review and assignment of work to staff responsible for timely and accurate registration and scheduling.  Performs audits and provides necessary training for scheduling staff.  Recommends and coordinates performance improvement initiatives under the direction of the manager/supervisor.  Actively provides excellent customer service by serving as the initial patient point of contact for TMC HealthCare and the Business office; facilitates access to the medical center services through use of computer based scheduling system or telephonic communication.  Processes inbound orders for scheduling, creating new patient records as required, contacts insurance payers to secure authorizations for services as required. 

ESSENTIAL FUNCTIONS:

Assists the Manager with the review, assignment, training, and direction to Patient Access Schedulers, to ensure the correct registration and scheduling processes are followed and operational procedures are documentation and posted for reference to all staff. 

Exhibits excellence in customer service through appropriate attitude and interaction with all patients, visitors and staff; adheres to and supports team members in exhibiting TMCH values of integrity, community, compassion, and dedication. 

Acts as point of service liaison for coordination of scheduling complex and/or STAT appointments and as a resource for resource management by responding to inquiries and addressing scheduling messages via host system.

Collects deposits or deductibles as required and advises patient or guarantor of insurance benefits and anticipated cost estimates; ensures cash handling follows corporate policies.

Ensures completion of financial documentation in accordance with TMCH’s credit and collection policies.

Performs medical necessity screening and ensures compliance with system requirements.

Explains all necessary compliance forms and obtains patient signature as required for regulatory agencies.

Interacts with physicians, physician’s office staff to secure diagnosis, procedure details or authorization information.

Trains and directs staff on how to monitor the referral workqueue and corrects errors in conjunction with the outpatient departments to ensure good clinical care and TMC’s ability to provide timely services are requested by the community providers.  .

Uses medical terminology and scheduling knowledge to select correct procedure when scheduling and coordinates information with other departments, if applicable.

Demonstrates knowledge of resources, staffing, instrumentation and equipment specific to procedures to avoid scheduling conflicts, if applicable. 

Performs patient registration activities to ensure accurate financial and biographical data and documentation have been obtained and properly entered into hospital records. 

Completes insurance processing; including account creation, insurance verification, notification, and authorization functions.

Updates and distributes information regarding patient demographics including insurance information.

Obtains required information from patients, other departments and physicians, as needed; communicates with patients or designated other parties regarding financial responsibility and collects payment for the same, if applicable.

Supports quality improvement initiatives through team participation, process change implementations and other activities.

Communicates and interfaces with hospital personnel, patients, medical staff, and family members to ensure high-quality patient care.  Established as point of contact for internal department personnel as a resource to guide and assist with complex scheduling and/or emergency cases.

Handles incoming telephone calls and exercises judgment in scheduling caller for correct procedure in appropriate service area; receives telephone requests to schedule from patients, physicians, physician office staff, employers, and hospital personnel, if applicable.

Updates, compiles, and distributes information regarding patient demographics including insurance information.

Explains procedure preparations to patients so they are properly prepared before arriving at the hospital, if applicable.

Documents all notification, authorization and eligibility information in the registration systems, uses electronic verification tools and web-based resources.

Interprets physician orders using medical terminology and scheduling knowledge to accurately transcribe faxed orders to facilitate the scheduling process.

Contacts insurance carriers by telephone for appropriate billing information such as authorization numbers, eligibility and benefits; documents all activity and additional information received in scheduling system.

Uses existing or new software to facilitate reconciliation of orders received to facilitate follow up for incomplete orders, authorizations and missing scripts via order images for electronically submitted orders to compliance and billing issues prior to patient appointments.

Establishes positive relationships with ancillary departments and specialty physician referring offices as a main point of contact.

Maintains appropriate filing systems, records, reports, and confidential files to ensure quick retrieval of information.

May prepare daily deposit and reconcile daily batch.

Adheres to TMCH organizational and department-specific safety and confidentiality policies and standards.

Performs related duties as assigned.

MINIMUM QUALIFICATIONS

EDUCATION:  High School diploma or General Education Degree (GED), or an equivalent combination of relevant education and experience.

EXPERIENCE: Preferred minimum of three (3) years related training or experience.  Applicants must have basic computer familiarity and experience.

LICENSURE OR CERTIFICATION: Heartsaver CPR (HSCPR or HSFACPR) certification required within ninety (90) days of employment for Pediatric Therapies department only. Certified Healthcare Access Associate (CHAA) certification or proficiency testing preferred.

KNOWLEDGE, SKILLS AND ABILITIES:

• Knowledge of office management practices, including billing and scheduling within healthcare.
• Ability to read or listen and comprehend simple instructions, short correspondence, and memos.
• Ability to write simple correspondence; ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization. 
• Ability to read and interpret documents such as safety rules, procedure manuals, and governmental regulations. 
• Ability to effectively present information and respond to inquiries or complaints from patients and/or their representatives and the general public.
• Ability to interpret and explain insurance benefits and patient financial responsibility. 
• Ability to apply common sense understanding to carry out simple/detailed written or oral instructions. 
• Applicants must have basic computer familiarity and experience and the ability to operate basic office equipment.