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The specialist is responsible for completing all outpatient scheduling functions for various hospital clinics, including verifying patient information, inputting data into the Hospital Information System (HIS), and ensuring scheduling aligns with policies for patient care and billing. Key duties also involve insurance verification, providing good faith estimates under the No Surprises Act, attempting pre-payment collections, and managing patient communications regarding appointments and preparation instructions.
Requirements summary
A high school diploma or equivalent is required, though personal computer/data entry experience and six months in a healthcare environment are preferred. Strong skills in telephone and interpersonal communication, teamwork, understanding medical terminology, and knowledge of medical insurance are necessary for success in this role.
We are looking for a Scheduling Specialist to join our collaborative team at Memorial Health!
What You'll Do
Complete all functions associated with outpatient scheduling
Schedules services for the following Hospital and Medical Office Building (MOB) clinics / departments; Diagnostic and Advanced Imaging, Diabetes Education and Nutritional Counseling, Endoscopy, Medication Therapies, Multipurpose Cath Lab, Non-Invasive Cardiovascular Lab, Respiratory Therapy, Sleep Medicine, Specialty Care, and Weight Management
Answers incoming phone calls within the pre-established guidelines per the policy and procedure manual and accurately provides all relevant information to callers
Correctly identifies patients by verification of three primary identifiers. Avoids duplicate medical record number (MRN) creation and reports duplicate MRNs when discovered
Gathers pertinent patient information during patient or provider office interactions, including demographic, financial and guarantor information, inputs the information into the Hospital Information System (HIS)
Reviews patient MyChart status, encourages MyChart activation, requests patient email addresses and inputs the information into the HIS. Sends activation invitations to patients upon initial entry and as requested
Ensures scheduling practices are consistent with internal policies and external requirements for expedient patient care and proper claims billing
Reviews and transcribes faxed orders and referrals into the HIS accordingly. Distributes faxed documentation as necessary to team members
Reviews daily, the various HIS scheduling workqueues to ensure ambulatory referrals and orders for testing are scheduled within expected timeframes. Prioritizes and acts upon urgent / emergent referrals and orders within the same day. Makes outbound scheduling call attempts within the pre-established guidelines per the policy and procedure manual. Documents all scheduling attempts in the referral communications
Completes as needed, medical necessity verification for Medicare outpatient tests and services that have Local Medical Review Policies (LMRP) / Local Coverage Determinations (LCD) in place and requests additional information from provider offices if needed to ensure compliance
Completes and documents scheduling decision tree questions with the patient to ensure appropriate scheduling location and considerations to ensure patient safety during service rendering
Benefits
Dental Insurance
Life Insurance
Paid Holidays
Sick Leave
Vacation
Vision Insurance
Medical Insurance
Flexible Spending Account
Tuition Reimbursement
Free Parking
Personal Day
Employee Recognition
Wellness Center
Kidzlink Daycare Center
Considers patient preferences during appointment scheduling. Considers insurance authorization determination timelines when scheduling testing / procedures as to allow enough time for pre-certification to be obtained without having to re-schedule the patient’s service
Documents referring provider information and diagnosis information along with any appropriate appointment notes
Creates the pre-encounter by selecting the patient class, creates the Hospital Account Record (HAR), assigns the correct guarantor and coverage(s). Ensures a referral is attached to the scheduled appointment
Finalizes calls with clear instructions to patients and/or provider offices regarding arrival time, location, and any preparation required for appointments, procedures or testing. Sends preparation instructions for procedures to patients in a variety of formats upon completing scheduling
Documents all incoming and outgoing communications (verbal and written) with patients, provider offices and insurance payors within the HIS as trained
Reschedules appointments timely due to patient requests, department / resource availability, or changes to the provider schedules. Places patients on waitlist as requested by the patient or ordering provider office
Cancels appointments timely due to patient request. Documents the appropriate cancellation reason for reporting purposes
Obtains provider / department approval when overbooking / overriding scheduling
Monitors the departmental shared outlook inbox, HIS secure chat, and HIS inbox messages daily. Acknowledges and responds to messages in a timely manner, ensuring all inquiries are addressed
Communicates and coordinates scheduling with other Hospital departments as needed for specific procedures/testing
Completes Endoscopy recall report monthly. Sends reminder notifications to patients for continuity of care
Insurance Verification and Benefit Collection
Contributes to the financial effectiveness of the Hospital by obtaining and/or reviewing scanned Medicare, Medicaid, and third-party insurance cards. Instructs patients to bring insurance card(s) and photo ID for scheduled appointments
Requests patient insurance information during each scheduling call, reviews for active coverage and benefits via the HIS insurance eligibility system and various web-based technologies
Proactively utilizes Insurance Discovery, MITS, and MyCGS tools to determine Medicare, Medicaid, and third-party insurance coverage details
Determines facility / insurance network status. If the patient is identified as having out-of-network insurance or a limited benefit plan, notifies the patient so they may make informed decisions about their care
Price Estimates and Pre-Service Cash Collections
Provides a comprehensive good faith estimate in compliance with the No Surprises Act (NSA) and upon patient request. Provides estimates verbally and in writing, complying with the NSA
Identifies NSA estimate needs via the HIS workqueue
Links estimates to scheduled encounters from referrals or creates estimates for prospective patients
Ensures applicable Hospital Billing (HB), Professional Billing (PB) and external provider charges are included on patient estimates
For self-pay, underinsured, and patients with out-of-network insurance, explains the self-pay discount rate, offers and screens patients for presumptive Medicaid, completing the data collection form at the point of scheduling to expedite the application process at check-in
If the patient is self-pay or underinsured and is seeking mammography services, provides contact information for the Breast and Cervial Cancer Program (BCCP)
Connects patients with financial assistance representatives for further assistance and Hospital Care Assurance Program (HCAP) applications
Makes attempts to collect patient pre-payments and good-faith deposits for outlined services. If successful in collecting monies during scheduling, provides the patient with an emailed receipt. As requested, provides patient refunds on the same day of collection. Reconciles all monies collected and closes the cash drawer daily
Patient Experience and Service Recovery
Informs supervisor of any significant delays in the scheduling process or patient experience issues
Demonstrates willingness and ability to go above and beyond to answer patient inquiries regarding scheduling processes, insurance questions, arrival instructions and test/procedure instructions
Respectful and courteous during interactions with patients, families, payors, and co-workers
Demonstrates a strong representation of Memorial Health’s values through attitude, actions, and communication with others
Displays enthusiasm while applying quick thinking and resourcefulness in providing assistance to a variety of patient needs
Receives patient concerns and complaints and provides resolution for readily resolved issues and escalation for more in-depth issues as appropriate to assist with service recovery
Ascertain and documents in the patient’s appointment and/or demographics any specific patient needs, including but not limited to, interpreter services, facilitation of transportation needs, equipment needed. Facilitates in-person interpretation when needed
Makes reasonable attempts to schedule patients for appointments and testing based on the patient’s preference for date, time and location
Maintains confidentiality at all times to protect patient privacy and adhere to HIPAA privacy and security regulations
Interpersonal
Acts as a resource for new employees and precepts as needed
All interactions will be conducted in a professional manner
Demonstrates a positive attitude
Provides excellent customer service, facilitates quality care delivery and fosters an atmosphere of understanding cultural diversity
Communicates dissatisfaction with issues to supervisor actively contributes to the solution of problems and refrains from promoting dissatisfaction among co-workers
Must be a team player; cooperate with co-workers to resolve conflict through one-on-one negotiation or with the assistance of the supervisor or their designee
Other • Exhibits behaviors reflective of Memorial’s core values
Compassion, Accountability, Respect, Excellence, and Service
Demonstrates regular and predictable attendance
Attends all mandatory education and in-services (i.e., team training, department staff meetings, safety, infection control, etc.); completes mandatory health requirements
Employee performs within the prescribed limits of the hospital’s and department’s Ethics and Compliance program and is responsible to detect, observe and report compliance variances to their immediate supervisor, or upward through the chain of command, the Compliance Officer, or the hospital hotline
Requirements
High school diploma or equivalent
Personal computer/data entry experience preferred
Six months working in the healthcare environment preferred
Experience with Microsoft Word, Excel and Outlook preferred
Strong telephone and interpersonal communication skills; teambuilding skills; understanding of medical terminology, medical insurance knowledge preferred;
Excellent customer service skills.
Shift
1st shift (8
30a-5p Monday - Friday)
Hours 80 per pay (Every two weeks)
Benefits
Medical Insurance
Dental Insurance
Vision Insurance
Life Insurance
Flexible Spending Account
Time Off
Vacation
Sick Leave
11 Paid Holidays
Personal Day
Retirement
Ohio Public Employee Retirement System
Deferred Compensation
Other
Tuition Reimbursement
Kidzlink Daycare Center
Employee Recognition
Free Parking
Wellness Center
Competitive Salaries
Community/Family Atmosphere
We look forward to seeing your application!
It is our commitment to inclusivity and diversity and our ongoing determination to provide a welcoming and inclusive environment for all staff and guests of the Hospital, regardless of age, color, disability, gender, gender expression or gender identity, genetic information, national origin, race, religion, sexual orientation, or veteran status. For any questions or needed accommodations, please contact Memorial Health Human Resources at 937.578.2701.
