GENERAL SUMMARY: The Rehab Reimbursement Assistant 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 cost share information. 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 outpatient rehab care areas will be required. The Rehab Reimbursement Assistant is best defined as a highly independent and flexible resource that functions in alignment with the patient experience initiative. Participates in quality assessment and continuous quality improvement activities. Performs all job duties and responsibilities in a courteous and customer-focused manner according to the Hurley Family Standards of Behavior.

SUPERVISION RECEIVED: Works under the direct supervision of Rehab Office Coordinator or a departmental director who reviews work for conformance to established policies and procedures.

MINIMUM ENTRANCE REQUIREMENTS:

• High school graduate and/or GED equivalent.
• Two 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, preferred.
• Knowledge of a call center environment and capable of handling a high call volume while maintaining high performance.
• Knowledge of registration, scheduling, insurance authorizations and verifications, obtaining prior authorizations, 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 others 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.
• Ability to work independently and make decisions in accordance with established policies and procedures.

1. Schedules, cancels, reschedules recurring appointments/services for designated outpatient rehab clinics. 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 requested by providers for all government and third-party payers, including emergent authorizations due to walk-in patients, post surgical, workers compensation, and those transitioning from inpatient to outpatient.
4. Resubmit authorization requests/extensions for all HMO plans, workers’ compensation, etc. when treatment plans are extended.
5. Contact referring providers and track all rehab orders and prescriptions to ensure timely receipt and reimbursement for continuity of care, to alleviate interruption of care.
6. Informs the patient of their visit-specific preparatory instructions and ensures notification about their upcoming appointments. Obtains all necessary information required by third-party payors for treatment authorization requests.
7. 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.
8. Educates the patient relative to their insurance policy/benefits. Refers patients who are uninsured/underinsured to a Financial Customer Service Specialist for financial assistance or governmental program screening and application processes.
9. 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.
10. Works with the billing 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.
11. Triages misrouted telephone and patient portal inquiries promoting an exceptional patient and provider experience. Makes follow-up calls to provider offices and/or payers to ensure receipt of all necessary information for the patient’s visit.
12. Recommends modifications to existing policies or workflows that support the values of Hurley Medical Center and will increase efficiency and promote data integrity.
13. 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.
14. Performs other related duties as required. Utilizes new improvements and/or technology that relate to job assignment. Involvement in special projects as needed.