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Work Shift

Day (United States of America)

Job Summary:

Responsible for working in collaboration with the Manager, Cancer Screening & Prevention and the Program Assistant-Cancer Screening to ensure the program's success and viability. Primary responsibilities are scheduling, precertification, carepricing, front end billing management, and data entry. Will assist with administrative tasks as needed by screening program or cancer administration.

Core Responsibilities and Essential Functions:

Responsible for all front end aspects of patient scheduling, precertification, coding, and revenue billing. Promptly answer lung screening intake line. Ensure voicemail box is checked frequently and that all calls are returned 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: o Confirmation of date, time, and location o Facility address o Billing/payment eligibility o Exam preparation Ensures appropriate precertification/authorization and Carepricer estimate are obtained for any exam or procedure allocated for submission through insurance using real-time eligibility, if applicable. Non-RTE payers will be verified via web or phone. Through the use of excellent communication and interpersonal skills, effectively obtains required eligibility, demographic, and insurance information from patients, payers, physician offices. 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 coordinator to any issue with potential to result in a billing or service recovery incident. Call 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 the Medical Imaging Lung Cancer Screening Orders & Referral Work Queues daily. Ensure order is valid and is linked appropriately to appointment in EMR, Image Now, or Trace as determined by ordering modality (electronic verses paper) . Responsible for entering mandated data elements into CMS national registry as required for revenue billing and reimbursement. Types with a high degree of accuracy and superior attention to detail when inputting data into registry software. Responsible for daily schedule and appointment reminder process to ensure compliant revenue billing based on accurate risk eligibility. Review DAR daily to identify and circumvent potential appointment/billing issues by ensuring patient is scheduled accurately and validity of orders. Steps to ensure compliance include: o Isolate by printing monthly list of upcoming follow up appointments. o Review patients history field and notate smoking history and reviewing/ordering MD o To ensure compliant billing, update visit type and send order corrections to ordering MD as determined by nurse coordinator. o Obtain and document both preauthorization and Carepricer estimate on all exams designated for insurance billing using most current department process. o Mail to patient appointment reminder letters with attached Carepricer estimates. Assist with other departmental functions and Cancer Program needs as requested or assigned. Utilize resources effectively to ensure a smooth and efficient working environment that promotes accountably for department duties and responsibilities. Maintain understanding of basic compliance functions following good clinical practice and WellStar institutional guidelines. Attend departmental meetings or community events when needed. Adhere to, support and embody WellStars customer service commitment to excellence: o Interacting respectfully and promote positive working relationship with co-workers, patients, referring office staff, and insurance company representatives in a friendly, personable and professional manner; o Assisting co-workers or other departments within Cancer Program when needed; o Flexible with hours to meet department needs; o Understands and utilizes existing lines of communication and authority, handles communications properly and is dependable and cooperative; o Views oneself as a reflection of the organization by following through on commitments and accepting ownership of and/or acknowledging mistakes; o Work collaboratively with the team to determine areas of optimization and develop solutions; o Takes responsibility for own actions, including the impact of those decisions on patients and others; and, o Acts in a way that demonstrates deep personal integrity and serves as a positive example. Performs other duties as assigned Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

• High School Diploma General or Accredited Program Health Science
• Associates Health Science-Preferred or Bachelors Health Science-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 2 years in a healthcare or radiology setting with experience in scheduling, insurance precertification and medical terminology. Required

Required Minimum Skills:

Strong customer service skills, good communication and organizational skills. Basic insurance carrier and pre-certification knowledge and computer skills. Basic typing and data entry experience. The individual must be able to communicate and understand verbal and written English language and display a positive attitude (see WellStars Standards of Gold and Values). 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 standard of dress as outlined with WellStar Health System dress code.

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