pre-Cert Clerk/outpatient Scheduler - Pain Management - Full-time

Company: State of Franklin Healthcare Associates
Location: Johnson City
Posted on: June 9, 2021

Job Description:

State of Franklin Healthcare Associates is currently recruiting for

a Full-Time Pre-Cert Clerk/Outpatient Scheduler to work with our Pain Management Team

Summary

The Pre-Cert Clerk / Outpatient Scheduler will work under the supervision of Clinic Manager to provide primary care in collaborative joint practice to patients and/or family members in the practice setting as requested. This position reports to designated practice Supervision/Administration. Supports and adheres to the State of Franklin Healthcare Compliance Program, to include the Code of Ethics and Business Standards by following professional conduct, dress code policy, maintaining patient, provider and staff privacy and confidentiality. The candidate will have the ability to communicate effectively and courteously with administration, providers, patients and staff. Works with the insurance carriers to obtain proper authorization and/or precertification. Records the information in Referrals Plus and notifies the patients of their appointments. Performs other clerical functions as assigned.

Essential Duties and Responsibilities

Outpatient Scheduler:

• Schedules outpatient diagnostic tests and referrals as ordered by the providers. Documents the tests and referrals in Referrals Plus.
• Maintains knowledge of insurance carrier requirements. Organizes and provides all necessary information to obtain the necessary authorization or precertification from the insurance carriers. Works with the referring provider to resolve insurance denials or requests for additional information.
• Notifies patients of their scheduled appointments. Documents their acknowledgement.
• Counsels patients regarding special preparations for their procedure and answers questions.
• Provides the patient with an order and/or any other necessary paperwork for their appointment.
• Performs other front office tasks such as filing and pulling medical records, answering the phones and covering positions as needed.
• Maintains strict confidentiality.
• Maintains a professional and courteous manner.
• Assists in special projects as assigned.
• Performs related work as required.

Pre-Cert Clerk

• Contacts Medicare, BlueCross BlueShield and other payers daily.
• Verifies the ODC order with electronic and paper pre-certification data by matching reports.
• Contacts insurance carriers to downgrade or upgrade pre-certs.
• Reviews claim denials.
• Verifies the completeness and accuracy of coding. Use resources such as the CPT and ICD-9 provider manuals, Medicare's Correct Coding Initiative, subscriptions, and publications to support correct coding. Reviews previous imaging reports and creatinine lab reports for studies such as CT and MRI performed at SoFHA, MSHA, and other outside entities.
• Follows up on unpaid carrier claims according to the balance and age of the charges.
• Contacts insurance carriers to verify the status of claims and resolve processing problems.
• Appeals claim denials as justified.
• Identifies problem payers and reports them to the Front Office Supervisor and ODC Imaging Director.
• Documents all insurance follow-up activity in IDX.
• Participates in educational activities.
• Maintains strictest confidentiality.
• Looks for trends of denials and reasons for those denials to minimize lost revenue.
• Maintains and updates list of insurance carriers and companies.
• Monitors changes in the insurance industry and notifies office staff of those and policies.
• Performs related work as required.

Other

Standard requirements for all positions.

• Compiles information and prepares reports.
• Maintains records.
• Participates in educational activities.
• Follows organizational policies and procedures, including State of Franklin Healthcare Associates Compliance Manual, Code of Ethics and Business Standards, HR Policies and Procedures Manual, Team Member Handbook, OSHA Manual and any other policies or procedures for the job function, department, location or clinic.
• Performs other duties as assigned.

Supervises

N/A

Qualifications

Education

High school diploma or GED.

Experience

One-year general clerical experience, preferable in a medical office setting. Word processing and computer experience. Familiarity with local insurance policies and their referral requirements.

Certificates, Licenses, Registrations

None

Competencies

Service: Demonstrates high standards of service to patients, physicians, team members and other departments; remains calm when faced with challenging or difficult situations; effectively resolves service issues.

Quality: Work is thorough and accurate; offers ideas and solutions to improve outcomes and enhance service; considers the situation and relevant information before taking action; effectively implements improvements.

Integrity: Acts with the highest levels of personal ethics, honesty and accountability.

Performance: Applies job specific knowledge, skills and experience to accomplish results; requires appropriate level of supervision; work is completed in a timely manner; uses sound judgement in decision-making; is reliable and dependable; utilizes time and resources responsibly; complies with policies and procedures; work area is organized, neat and clean.

Communication: Expresses facts and ideas in a clear, convincing and organized manner; listens effectively; professional, respectful and compassionate in communications with others; follows proper channels of communication and shares essential information timely; maintains appropriate confidentiality.

Teamwork: Builds and maintains effective working relationships; recognizes strengths and contribution of others; manages and resolves conflicts in a positive and constructive manner.

Additional Competencies for Managers/Supervisors

Leadership & Management: Sets and pursues key business objectives; monitors performance indicators to deliver results; inspires team to achieve goals; establishes realistic budget and demonstrates fiscal accountability; manages resources to maximize efficiency and effectiveness; creates atmosphere of teamwork and effective communication; recognizes and effectively utilizes team member skills and abilities; team members supervised demonstrate competence, productivity and high morale.

Working Conditions

(If the job requires a person to work in special working conditions this should be stated in the job description. Special working conditions cover a range of circumstances from type of working environment, regular evening and weekend work, shift work, working indoors/outdoors, working with challenging clients, travel and so forth.)

Work is performed in a medical office environment involving contact with patients, physicians, staff, insurance carriers and other business partners. Occasional local travel between work sites and additional hours, including evening or weekend work, may be necessary.

Physical Requirements

Not Required

Occasional

Frequent

Continuous

Walking

X

Standing

X

Sitting

X

Lifting

up to 10 lbs

X

up to 25 lbs

X

X

up to 50 lbs

X

Assisted lifting

X

Climbing

X

Bending

X

Pulling

X

Pushing

X

Vision

X

Color Vision

X

Hearing

X

Speaking

X

Chemicals/PPE

X

Pathogens/PPE

X

Outside Work

X

Additional Physical Requirements or Comments:

State of Franklin Healthcare Associates reserves the right to alter, change or modify this job description at any time, with our without notice. The duties and responsibilities contained herein are considered representative, but not necessarily all-inclusive, of the duties and responsibilities, which may be required of a job incumbent. All other categorizations contained herein are meant to be representative of the general environment or working conditions in which the job is performed.

Keywords: State of Franklin Healthcare Associates, Johnson City , pre-Cert Clerk/outpatient Scheduler - Pain Management - Full-time, Other , Johnson City, Tennessee