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Job Summary:

Via telephonic encounters executed onsite in Comprehensive Breast Health Program base, works in collaboration with the program team of Breast Health Facilitators, Schedulers Cancer Screener and Breast Health Navigators to ensure prompt, and efficient delivery of Comprehensive Breast Health Program services, communication, and results. Initiates communication of critical findings and escalates to Breast Health Nurse Navigator for review. Responsible for overall cancer screening workflow processes, including, precertification, care estimates, preauthorization, appointment scheduling, BIRAD workflow prioritization and execution, surgical consults, order transcription etc. Responsible for additional lay care pathway coordination activities to include barrier mitigation, administrative duties as assigned, and data entry.

Core Responsibilities and Essential Functions:

- Responsible for prompt and accurate coordination, communication, and dissemination of Breast Health test results delivery process with accuracy
- Works in close collaboration with program assistant or resource coordinator and Breast Health Nurse Navigator to ensure timely notification, disposition, and delivery of test results and clinical follow up (e.g., biopsy scheduling, surgical consults, benign high risk test results, pathology results, etc.)
- Following a protocol, reviews clinical report to determine level of urgency and navigates findings to appropriate clinical pathway
- Routes findings to Breast Health Nurse Navigator to initiate plan of care.
- Initiates and disseminates result letter to patient and designated physician(s)
- Responsible for prompt and accurate coordination, communication, and dissemination of Breast Health test results delivery process with accuracy
- Works in close collaboration with program team and breast health nurse navigator to ensure timely notification, disposition, and delivery of test results
- Accesses Epic and other resources daily in preparation for screening workload and track patient completion of exams
- Making assessment of and helping to connect patient to resources to mitigate completion barriers (e.g., transportation, financial)
- Responsible for all front-end aspects of patient scheduling, precertification, coding, and revenue billing.
- Promptly answer Comprehensive Breast Health Program intake line. Promptly initiates outreach for assigned BIRAD dashboard working closely with Breast Health Nurse Navigator on coordinating care for BIRADs 3, 4, 5 patients.
- Enters orders and schedule appointments based on systematic reporting guidelines and/or reviewing physician recommendation.
- Ensure the voicemail box is checked frequently and that all calls are returned the same day unless received after-hours.
- Ensures patients are scheduled appropriately based on screening criteria and eligibility.
- Communicates clearly and effectively to patients scheduled all critical appointment elements such as but not limited to:
- Confirmation of date, time, and location Facility address
- Billing/payment eligibility
- Exam preparation
- Ensures appropriate precertification/authorization and care estimate are obtained for any exam or procedure allocated for submission through insurance using real-time eligibility (RTE), if applicable. Non-RTE payers will be verified via the web or phone.
- Using excellent communication and interpersonal skills, effectively obtains required eligibility, demographic, and insurance information from patients, payers, physician offices.
- Obtain and document both preauthorization and care estimate on all exams designated for insurance billing using most current department processes.
- Verify the accuracy of data obtained/entered and correct any errors.
- Ensures orders are complete and contain appropriate diagnosis codes or mandated data elements as required by payer for reimbursement.
- Keeps current on internal and external insurance/reimbursement updates as related to private insurance or CMS guidelines.
- Identifies and alerts program coordinator to needed practice changes to ensure billing process.
- Maintains working list of insurance carriers and stays current on reimbursement policies.
- Proactively identifies and takes measures to circumvent any concerning issue with potential to result in billing complaint or service recovery incident.
- Alerts program supervisor/manager to any issue with potential to result in a billing or service recovery incident.
- Call and/or fax physician offices to obtain orders as needed.
- Advise patient/office of ABN requirement if necessary.
- Ensure appointment notes are accurate and that pertinent insurance authorization information is thoroughly documented in a consistent manner utilizing the EMR so that information is clear and accessible by pre-registration, PAS, medical imaging, and revenue integrity departments.
- Review and work breast cancer screening, diagnostic or related orders associated work queues, dashboards, or DARs daily.
- Ensures order is valid and is linked appropriately to appointment in EMR, or other system as determined by ordering modality (electronic verses paper).
- Collects, enters, and tracks data as currently mandated for designated database and research registries.
- Maintains oversight and take ownership for all data entry and accuracy of data
- Collects complete, accurate and pertinent data included disease status, recurrence information,
- Ensures compliance with any required or other data requests from leadership
- Manage time and prioritize job responsibilities to meet changing demands of workload as determined by volume
- Attends health fairs, community events or various outreach opportunities to promote education and awareness
- Provide administrative support for special projects as assigned
- Transport documents as needed for case review, obtainment of signatures, and/or delivery of collateral to physician offices, screening locations and/or other medical facilities
- Attend departmental meetings, conferences, seminars as assigned
- Cross-training to complete other departmental tasks as needed
- Generates computerized monthly productivity reports from ACR designated registry

Required Minimum Education:

High school diploma or GED equivalent from accredited institution Required
Degree in healthcare (or extensive experience working in clinical or administrative setting) Preferred

Required Minimum License(s) and Certification(s):
All certifications are required upon hire unless otherwise stated.

Additional License(s) and Certification(s):



Required Minimum Experience:

Minimum 3 years experience working in clinical or administrative setting Required
Must have experience or strong understanding of data entry, and abstraction, billing and coding, scheduling, and insurance precertification Required
Experience with Microsoft Word, Excel, required. Must be knowledgeable about medical terminology. Required
Experience working with registries or databases is a plus Preferred

Required Minimum Skills:

Excellent customer service skills, highly effective communication, and organization skills.
Team player who easily adapts to change and can work in a modular office environment with a team of Breast Health Facilitators, Schedulers Cancer Screening, and Breast Health Nurse Navigators.
This position requires a high level of attention to detail and a low error rate, as the consequences of even a minor mistake can be significant for patients and providers.
In addition, this position requires regular, reliable attendance and adherence to professional standards of dress as outlined in the Wellstar Health System dress code.
Desire to learn and grow, willing to take on new projects/tasks as assigned, and manage multiple projects/tasks simultaneously.
Must have a strong sense of urgency, work well under pressure, and have strong reading comprehension skills to be successful in this role.
Demonstrated ability to establish and maintain collaborative and productive relationships with coworkers and is able to manage multiple projects/tasks simultaneously.
Must possess the ability to make decisions independently and to discern when to escalate issues as needed.

Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.