The Central Scheduling Specialist coordinates the verification, scheduling, pre-registration, and authorization for medical services. Responsibilities include the accurate collection and entry of required financial and demographic patient information, scheduling management to maximize the efficiency of the visit, communicating preparatory instructions, and collection of payment. This role requires a high level of independent judgment in order to successfully coordinate and obtain authorization requests for governmental and complex managed care patients in a timely and efficient manner. Utilizing telecommunications and computer information systems, this individual will be responsible for handling inbound and outbound calls with a focus on exceptional service to patients, employees, and providers. In order to ensure an extraordinary patient experience, multitasking between different patient care areas will be required. The Central Scheduling Specialist is best defined as a highly independent and flexible resource that functions in alignment with the patient experience initiative. Performs all job duties and responsibilities in a courteous manner according to the Hurley Family Standards of Behavior.Works under the supervision of the department director or designee who assigns and reviews conformance with established procedures and standards.

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High school graduate and/or GED equivalent.

Associate's degree in Business Administration or equivalent degree.

-OR-

Two (2) years of experience working in a call center or experience performing scheduling, registration, billing or front-desk responsibilities in a medical (hospital or physician office/clinic) setting

Knowledge of a call center environment and capable of handling a high call volume while maintaining high performance.

Knowledge of registration, scheduling, authorization, and referral policies and procedures relative to an outpatient clinic and surgical setting.

Demonstrates extensive knowledge of insurance plan pre-certification/referral requirements and processes.

Working knowledge of medical terminology, procedure and diagnosis coding, and billing procedures.

Proficient in business office information systems & software such as Google Suite & Microsoft Office containing spreadsheet and database applications.

Manage multiple, changing priorities in an effective and organized manner, under stressful demand while maintaining exceptional service. Maintain composure when dealing with difficult situations and responding professionally.

Independently recognize a high priority situation, taking appropriate and immediate action. Make decisions in accordance with established policies and procedures.

Knowledge of hospital operations and / or Ambulatory Clinic operations.

Excellent verbal and written communications skills and a pleasant and professional phone demeanor.

Ability to develop effective relationships with colleagues, physicians, providers, leaders, and other across the organization.

Demonstrates a genuine interest in helping our patients, providers, and other employees by using excellent communication skills, being polite, friendly, patient and calm under pressure.

PREFERRED QUALIFICATIONS: Working knowledge of Epic Revenue Cycle applications: Resolute Hospital Billing, Resolute Professional Billing, Single Business Office, Cadence, or Grand Central.

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1. Schedules, cancels, reschedules appointments / services for designated departments. Manages scheduling to maximize the efficiency of the visit / provider. Monitors appointment schedules daily for cancellations, rescheduling, and no shows as well as other stats or changes; communicates timely with all departments impacted. Generates daily-weekly-monthly reports in order to manage schedules and distributes information as needed.


2. Performs pre-registration functions within designated time frame in advance of the patient appointment (including, but not limited to) obtaining and / or verifying demographic, clinical, financial, insurance information, and eligibility for scheduled service / procedure. Confirms Primary Care Provider making necessary updates as appropriate.


3. Identifies insurance companies requiring prior authorization and / or referrals for services and obtains authorization / referral for all services. Coordinates incoming / outgoing authorizations for procedures and testing requested by providers for all government and third-party payers, including emergent authorizations due to walk-in patients.


4. Informs the patient of their visit-specific preparatory instructions and ensures notification about their upcoming appointments. Schedules pre-admission testing when needed and assists in arranging necessary lab orders. Obtains all necessary information required by third-party payors for treatment authorization requests.


5. Courteously accepts and places telephone calls, and interacts with physicians and associates while providing services. Resolves or tactfully directs complaints, problems; obtains information and responds to inquiries within 24-48 hours. Frequently communicates with patients/family members/guarantors, physicians/office staff, medical center, and payors via telephone, email, enterprise EMR or other electronic services. Escalates issues that cannot be resolved in accordance with departmental guidelines.


6. Performs price estimates upon patient request in order to assist the patient in identifying their expected full patient liability and / or residual financial responsibility.


7. Educates the patient relative to their insurance policy / benefits. Collects patient / guarantor liabilities and refers patients who are uninsured / underinsured to Insurance Services Specialists for financial assistance or governmental program screening and application processes. Refers patients to the Financial Customer Service Specialist to resolve outstanding self-pay balances.


8. Maintains a log / guide with up-to-date information related to services in need of pre-certification or require referrals per insurance carrier. This includes compliance with regulatory requirements and ensuring all changes are incorporated into daily job functions.


9. Works with the coding department to validate the accuracy of the authorized service in comparison to the procedure performed. Discrepancies are addressed immediately within timelines set forth by the specific payer's guidelines for correction. Reports procedural updates to leadership.


10. Triages misrouted telephone and patient portal inquiries promoting an exceptional patient and provider experience. Makes follow-up calls to provider offices and / or testing sites to ensure receipt of all necessary information for the patient's visit.


11. Recommends modifications to existing policies or workflows that support the values of Hurley Medical Center and will increase efficiency and promote data integrity.


12. Maintains thorough knowledge of policies, procedures, and standard work within the department in order to successfully perform duties on a day-to-day basis. Able to work in a fast-paced call center environment while maintaining efficiency and accuracy.


13. Performs other related duties as required. Utilizes new improvements and/or technology that relate to job assignment. Involvement in special projects as needed.