Surgery Scheduler & Precertification (Clinic) F/T Day
Company: Prisma Health
Posted on: May 8, 2022
Inspire health. Serve with compassion. Be the difference.
Responsible for scheduling and pre-certing all OR cases requests
and pre-assessment appointments. Must have clear understanding of
payors requested information to obtain all pre-cert documentation.
Must have a full understanding of CPT codes and ICD-10 codes for
pre-cert process and OR appointment placement. Must have a full
understanding of Epic Surgery Case workflow and how to submit
pre-op orders for second signature and snapboard placement.
Responsible for the clinical aspects of all referrals made to the
program, including logging all referrals, collecting and cerifying
pertinent demographic as well as obtaining pre-certifications and
authorizations for new and ongoing treatment. Interacts regularly
with internal customers, third party payors and outside referral
sources Understands how to obtain pricing for OR cases, request and
obtain pre-surgical payment as needed.
* Performs all OR Surgery Case requests for Surgeons along with all
pre-op order sets and any pre-surgical clearance. Must have full
understanding of Epic OR cases request workflow and second sign
authorization for surgeons. Must understand the difference between
orders for pre-assessment appointments vs. day of OR orders and
place these orderss in the appropriate time frame in Epic. Also,
works the pre-certification WQ to ensure all authorization has been
obtained 3 days prior to surgical case. Communicates with the OR
schedulers to ensure cases are placed on snapboard in correct
blocked schedule. Communicates with patient and families regarding
pre-assessment time, pre-surgical orders, day of surgery
appointments and post op appointment times.
* Processes and tracks incoming referrals for ancillary requests.
Logs all incoming referrals according to program guidelines.
Obtains medical records to support referrals. Prepares referral
with clinical and financial information for submission to Institute
Manager. Coordinates patient assignment to case management and
communicates with referral source as to the status of the
* Collects and verifies pertinent patient demographics and
financial data for all new patient referrals with physician offices
and other referral sources. Communicates with referral source to
obtain additional information required for completing referral,
including ICD-10 coding as well as ascertaining appropriate medical
records to determine eligibility for program admission.
* Advocates for and secures coverage for all patients referred for
services that can include OR cases and radiology procedures.
Explains the unique aspects of the program to insurance
representatives and provides the program description to all third
party payors in order to increase accuracy of pre-certification
determinations and financial information. Verifies insurance
benefits to include all possible services and CPT codes billed by
program and need for pre-certification orb pre-authorization for
treatment. Pursues any needed clarification of insurance benefits
prior to scheduling of patients.
* Performs compliance functions related to coding, billing,
demographics and payor source. Facilitates ICD-10 codes on initial
orders. Coordinates supplemental ICD-10 coding to support medical
necessity of treatment and communicates to Prisma Health Medical
Information Department in a timely manner. Monitors timeliness of
physician continuing orders for treatment for all program and PRN
This is a non-management job that will report to a supervisor,
manager, director, or executive.
* High School diploma or equivalent
* 2 years of experience in Insurance, billing, collections,
customer service and/or healthcare business office
In Lieu Of The Above Minimum Requirements
Other Required Skills and Experience
Knowledge of ICD-10 and CPT coding conventions preferred
Day (United States of America)
Patewood Outpt Ctr/Med Offices
1046 Patewood Hospital
Share your talent with us! Our vision is simple: to transform
healthcare for the benefits of the communities we serve. The
transformation of healthcare requires talented individuals in every
role here at Prisma Health.
Keywords: Prisma Health, Greenville , Surgery Scheduler & Precertification (Clinic) F/T Day, Healthcare , Greenville, South Carolina
Didn't find what you're looking for? Search again!