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Surgery Scheduler & Precertification (Clinic) F/T Day

Company: Prisma Health
Location: Greenville
Posted on: May 8, 2022

Job Description:

Inspire health. Serve with compassion. Be the difference.

Job Summary

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 referral.
* 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 patients.

Supervisory/Management Responsibility

This is a non-management job that will report to a supervisor, manager, director, or executive.

Minimum Requirements

* High School diploma or equivalent
* 2 years of experience in Insurance, billing, collections, customer service and/or healthcare business office

Required Certifications/Registrations/Licenses


In Lieu Of The Above Minimum Requirements


Other Required Skills and Experience

Knowledge of ICD-10 and CPT coding conventions preferred

Work Shift

Day (United States of America)


Patewood Outpt Ctr/Med Offices


1046 Patewood Hospital


10457822 Surgery-Vascular-IVH

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

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