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Qualifications:
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Central Scheduler
- Graduation from high school or equivalent is required
- Previous experience in appointment scheduling in a health care environment is required (e.g., physician office, clinic or hospital)
- Experience in customer service is very desirable
- Hospital registration or admitting experience is desirable
- Experience working with insurance authorization departments and contracts desirable
- Knowledge of medical terminology and familiarity with medical diagnostic procedures, and health care billing and authorization is required
- Must be highly skilled in verbal communications, problem solving, and prioritization and organization
- Must be thorough and able to follow detailed instructions
- Must be able to meet tight time frames and have excellent customer service skills
- Typing speed of 45 WPM, and basic experience with main frame computers, calculators, copiers, FAX machines, and multi-line phone systems required
- Ability to work with speed and accuracy while completing multiple projects is required
Financial Counselor
- High School graduate or equivalent required
- Two years of hospital experience and working knowledge of all patients accounting functions, including pre-admissions and admission registration
- Demonstrated experience in credit, collection and billing is required, preferably in a hospital setting
- Ability to interpret billing manuals, insurance and/or other third-party coverage
- Understanding of the third-party review process
- Understanding of payer funding and authorization procedures to ensure payment
- Understanding of government/state payers, including eligibility factors
- Knowledge of medical and insurance terminology is required
- Ability to type 45 WPM
- Must be proficient in the use of office machines, including computers
- Must have excellent interpersonal and telephone skills
- Must have effective written and verbal communication skills
- Must posses patient interview techniques
- Must obtain the ability to prioritize workload and possess ability to meet tight time frames
- Must obtain the ability to work under minimal supervision, is detail oriented and possess problem-solving skills
- Must be able to withstand a frequent amount of working at a computer terminal
- Must obtain the ability to concentrate on detail in the middle of other activities
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Duties &
Responsibilities:
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Job Summary
The Central Scheduler schedules appointments, for various hospital departments, including Imaging Services, Cardiology, Nuclear Medicine, Respiratory Therapy and Same Day Surgery Procedures. The scheduler receives routine functional guidance from the Central Scheduling Supervisor and the Supervisor of Admitting/Registration, concerning community agencies and resources and to make appropriate patient referrals. The scheduler schedules approximately 40 patients per day, and has the authority to make appointments for hospital departments according to the schedules they provide. The scheduler will follow very specific protocols in scheduling and the collection of financial information. However, they will have to be alert constantly for special cases which they will normally refer to the Supervisor.
The Financial Counselor performs the quality control function for inpatient accounts, outpatient surgeries and outpatient radiology, ensuring all pertinent information is available and accurately documented, allowing for timely and efficient billing. These activities include generating weekly status reports, communication with multiple departments, monitoring accounts for proper documentation of third party review notification, authorizations, insurance verifications, collection of deposits and self pay balances, securing reimbursement methods of non-insured admits, computer update of accounts and the collection of verification of relevant patient data.
Duties
Central Scheduler
- The Scheduler assures that patients have all information they need so that they will arrive on time and prepared for their procedures and that the hospital has all of the information required to bill properly for its services
- Receives requests to schedule procedures from physician offices and patients and schedules the procedure according to the availability of the various departments
- Provides accurate information so that all departments may view and print the schedule for the appointments daily, and maintains open communication with hospital departments regarding schedule changes
- Performs other duties as assigned
Financial Counselor
- Follows policy and procedures in regard to financial screening, arrangements and third-party demands
- Verifies and assures all accounts are ready for billing with adequate supporting documentation, within the established time frames
- Serves as support to patients and their family members to assure customers have access to all available funding, this involves; working with private as well as governmental agencies; i.e., private insurance, HMO/PPO’s, Medi-Cal, Medicare, Champus and Worker’s Compensation
- Initiates and completes charity applications on accounts at risk for completing Medi-Cal application requirements and installment agreements
- Maintains daily contact with Utilization Management, Business Office, Patient Registration, Medical Records, Ancillary departments, various third-party agencies, HMO/PPO’s, patients, their families, physicians, offices and other outside entities
- Reviews financial data to determine possible Medi-Cal eligibility and verifies with POS/AEVS
- Assists patients in completing State and county medically indigent application forms and schedules appointments for patients with on-site County eligibility worker
- Determines possible eligibility for charity assistance, Charity Policy, Proposition 99 Funding, and SB12
- Prepares accounts for Supervisor’s approval
- Bills appropriate state or federally funded programs and follows required procedure for patient eligibility and/or transfer
- Determines patients ability to pay and secure repayment arrangement with patient, according to Oroville Hospital established polices
- Provides comprehensive audit and analysis
- Updates all inpatient, outpatient, and surgery accounts to ensure completeness and accuracy
- Exercises problem solving skills independently and update system to resolve any patient account delay
- Monitors appropriate turn around on all accounts to ensure the business office within established time frames receives accounts
- Assures proper financial classification, determines proper guarantor and updates system accordingly
- Verifies Medicare eligibility utilizing DDE for appropriate coverage relation to service to be rendered
- Identifies if an HMO or Hospice is managing Medicare benefits
- Performs third-party certification/verification on Medicare HMO accounts
- Verifies Medi-Cal coverage for other coverage and restricted services
- Investigates Medi-Cal overage for other coverage and restricted services
- Obtains needed authorization for scheduled Medi-Cal accounts requiring 50-1 and forwards to Utilization Management when received
- Always handles all patient/family contact in a courteous, professional manner
- Consistently interacts with sensitivity to patients/their families and is responsive to individual needs
- Receives and places telephone calls in a skillful manner using appropriate etiquette
- Handles all telephone requests with courtesy, accuracy and respect for confidentiality
- Provides estimates for procedures to patients, physicians’ offices, and payers as requested
- Consistently follows/reviews third-party guidelines for review notification and contract coding of patient accounts
- Alerts Supervisor/Director to patterns in problem areas in order to initiate situation resolution
- Alerts Supervisor if extended payment arrangements are needed to obtain approval from UM Director
- Reviews each account for specific third-party billing requirements, including necessary document for prompt billing
- Coordinates necessary activities with external review agents to ensure timely receipt of all third-party certification required for billing
- Review account to assure that all third-party identification codes are used correctly according to documentation in computer system
- Staff resource to hospital departments for information related to documents and other information necessary for billing
- Contacts referring provider in a timely manner if needed authorization is not initiated on scheduled accounts
- Utilizes UM Department as a resource for scheduled accounts when authorization cannot be obtained prior to service to determine medical urgency
- Reviews daily pre-op, surgery and outpatient schedules generated to ensure account information is complete prior to services rendered
- Obtains necessary referrals, authorization and pre-certifications as needed
- Obtains patient demographic data not captured during scheduling process, which is necessary for claims processing
- Determines co-pay, share of costs and deductible status using information obtained during verification process
- Contacts patient prior to service to advise of Oroville Hospital’s policy regarding co-pay and prepares installment agreement, if needed
- Documents accounting in billing revisions and notes to include verification, authorization, and co-pay to be collected by Patient Registration Representatives at time of procedure
- Forwards all needed paperwork for outpatient procedures to Patient Registration Representatives to be added to account folder to ensure timely billing
- Completes and submits a weekly cash collection report
- Completes and submits a weekly productivity report
- Demonstrates commitment to total quality management through knowledge of its precepts, skillful workplace applications and continuous organizational improvement
- Exhibits a customer/supplier philosophy that emphasizes both internal and external relationships
- Identifies both customer and supplier needs/expectations and strives to exceed them
- Actively participates in and encourages others to utilize creative and innovative approaches to accomplish tasks
- Demonstrates responsibility for ongoing personal development, professional growth and continuing education
- Performs duties in a self-directed manner with minimal supervision or direction
- Ensures that routine and priority tasks are completed within established departmental time frames
- Demonstrates a clear understanding of and consistently adheres to department and facility policies and procedures
- Attends and actively participates in department and facility meeting and classes, including annual fire, safety and disaster programs
- Follows safety procedures, operates equipment and performs job related duties in a safe manner which prevents accidents from occurring
- Performs other duties as assigned
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Other Info:
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Lifting Requirements:
This position requires periods of extensive sitting and phone work. It also requires other repetitive motions (e.g., bending, stooping, and twisting, walking, standing, reaching overheard, pushing or pulling). Generally lifting objects not more than 25 lbs. and/or carrying objects weighing 10 lbs. Repetitive motion (i.e. bending, stooping, twisting, walking, standing, sitting, reaching overhead, pulling or pushing). Manual dexterity required.
Manual dexterity is required, as is the ability to concentrate on detail in the midst of other activity.
Sedentary- generally not more than 10 lbs. maximum and occasionally lifting and/or carrying such articles as ledgers, files and small items.
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