Position: ASC Intake Coordinator and Prior Authorization

Summary of Duties for intake Coordinator: Greet patients and visitors to IPMR Surgery Center, obtaining all required patient demographics; other information and directing to the appropriate person.   Answer and direct all incoming calls in a courteous, efficient manner.  Have general clerical duties. Needs good computer skills. Will be cross trained to all non-licensed areas in the ASC.

Summary of Duties for Prior Authorization: Responsible for verifying and obtaining authorizations as required by insurance, depending on plan coverage for all procedures in ASC and office. Responsible for reviewing upcoming schedules for insurance eligibility and to verify referrals are in place for payers in which they are required.  Contact patients for updated insurance information and/or out of pocket estimates. Coordinates with billing, AMA’s, CMA’s and ASC when needed. 

SUPERVISION RECEIVED: Reports to IPMR Director of Nursing and our Business Office Manager. Director of Nursing is the first point of contact. May receive directions from the Administrator and/or Physician

Essential Function for Intake Coordinator:

1. Schedules all procedures to be performed in the ASC.
2. Maintains daily schedule and prints schedule for pre and post-op/OR areas.
3. Obtains ABN forms as necessary.
4. Answers telephone in polite, prompt, helpful manner.  Direct calls to the appropriate person and/or takes accurate messages when needed
5. Greets and admits patients and visitors to IPMR ASC in polite, prompt, helpful manner. 
6. Obtains all patient identification, demographic information and insurance information.
7. Verifies and updates all patient identification information, demographics and insurance information within accounts receivable computer system.
8. Enter patient demographic information as well as continually updating eClinical patient status.
9. Notifies patients upon arrival of co-pays and other financial arrangements as needed.
10. Coordinates with business office on any patients requiring payment plans or financial counseling.
11. Works with business office to enhance collections of patient fees and accurate insurance billings.
12. Track patient arrivals, rescheduled appointments and no-shows to report as needed.
13. Maintains a clean, orderly reception area including plants, reading material (no reading materials to be older than 6 months) and art.
14. Scans documents and organizes charts for procedures.
15. Review procedure requests and physician’s orders, update and send to the appropriate files.
16. Anticipate and solve problems from all above areas of responsibility, with the primary consideration being the efficiency of the physicians and the center as a whole.
17. Comply with HIPAA Policies and Procedures and adhere to Confidentiality Policy
18. Will participate in all PI (performance improvement) projects.
19. Other duties as requested

Essential Function for Prior Authorization:

1. Responsible for obtaining authorizations from insurance companies
2. Verify patient insurance coverage and benefits
3. Submit necessary documentation to insurance companies to establish medical necessity.
4. Maintain accurate and up-to-date records of all prior authorization requests and approvals
5. Communicate effectively with healthcare providers to gather required clinical information.
6. Requires working knowledge of payer medical policies, along with National and Local Coverage Determinations (LCD) and will coordinate with physicians for any prior authorization denials or LCD coding questions.
7. Responsible for contacting patients with out-of-pocket costs for procedures. (This may include looking up insurance specific fee schedules to calculate out of pocket costs.)
8. Responsible as back up for the other Prior Authorization Coordinator duties as needed and each will provide coverage for the other during an absence.
9. Follow up with Insurance companies on pending authorizations.
10. Address and resolve any issues related to prior authorization denials.
11. Work with the billing department to ensure accurate coding and billing of authorized procedures.

Experience:. Minimum of two years’ experience working in a group practice or healthcare system is preferred. Understanding clinic operations related to patient registration, referrals, and authorization

Education: High school graduate or equivalent.

Skills:

1. Skill in establishing and maintaining effective working relationships with other employees, patients, organizations and the public
2. Good computer skills.
3. Skill in gathering, analyzing, and evaluating patient information
4. Skill in written and verbal communication.
5. Skills in gathering, analyzing, and evaluating insurance information.

Abilities:

1. Ability to read, understand and follow oral and written instruction.
2. Ability to sort and file materials correctly by alphabetic or numeric systems.
3. Ability to communicate clearly.
4. Ability to prioritize and handle many tasks/projects simultaneously
5. Ability to be proactive -- anticipate problems before they occur.
6. Ability to be self-directed, work alone.

ENVIRONMENTAL/WORKING CONDITIONS:   Work is performed in a busy office environment and requires desk work.  Frequent contact with employees, patients and outside agencies.   Public contact may involve dealing with angry or upset people.  

PHYSICAL DEMANDS: Standing and sitting required for extended periods of time.   Manual dexterity for using a calculator and computer keyboard.  Some bending and stooping are required.