Scheduler-Full Time-Days
Cape Fear Valley Health
Summary
Obtains and/or verifies demographic, clinical, financial, and insurance information in the process of appointment making for patient tests and procedures, pre-registering and financial clearing for service delivery. Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance. Additionally, the incumbent obtains and processes signed physician orders to ensure clinical documentation for care delivery. The incumbent conducts online insurance eligibility/benefit verification, pre-certification/authorization, referral clearance and financial education on designated cases. As appropriate, the incumbent notifies patient/guarantor and collects patient liabilities, and refers appropriate cases to resource counseling for follow-up and consultation.
Job description
Major Job Functions
- Receive orders and schedule outpatient appointments for all modalities except biopsy and special procedures and all radiology outpatient facilities
- Determines proper scheduling requirements and/or limitations according to requested tests/procedures and schedules resources (equipment, staff, room, etc.)
- Coordinates add-on and same-day appointments as required
- Ensures proper test sequencing with minimal patient delays, when multiple testing is required.
- Performs insurance eligibility/benefit verification, utilizing a variety of mechanisms (EDI transactions, web access and by calling payers) and documenting information within the appropriate registration system; supporting with reference number.
- Pre-registers the patient for upcoming visit(s).
- Calls patient to remind of appointment date, time, location, and preparation for procedures following protocols; as well as informs the patient of their financial responsibility, answer questions and give directions.
- Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance.
- Informs patient/guarantor of their liabilities and collects appropriate patient co-payments, co-insurances, deductibles, deposits and outstanding balances at the point of pre-registration.
- Provides patient, family and physician office education during scheduling process to inform them of preparations needed for diagnostic testing and proper scheduling instructions
- Sends and/or communicates appointment confirmation to referring office
- Reconciles charge reports daily and communicates errors to staff
- Other duties as assigned
Minimum Qualifications
Education and Formal Training
- High school diploma or equivalent required
- College courses in Business or Health Care Administration and/or Computer Technology preferred
- Medical terminology required within one year of employment
Work Experience
- 1 year insurance/clerical experience within a hospital or medical office setting preferred
Knowledge, Skills, and Abilities Required
- Proficiency in reading, writing, and speaking the English language
- Must pass pre-employment testing and post-training testing
- Must have knowledge of insurance and collection of payments
- Must have experience with Microsoft software
- Must possess excellent verbal and written communication skills, customer service skills and problem-solving abilities
- Must be multi-skilled with the ability to appropriately handle complexity and stress with the changing needs of the patients, families, visitors, and the Health System
- May be required to periodically rotate shifts and regular days off
- All system employees must have the flexibility to meet the department hours of operation
Requirements
- High school diploma or equivalent required
- Medical terminology required within one year of employment
- Proficiency in reading, writing, and speaking the English language
- Must pass pre-employment testing and post-training testing
- Must have knowledge of insurance and collection of payments
- Must have experience with Microsoft software
- Must possess excellent verbal and written communication skills, customer service skills and problem-solving abilities
- Must be multi-skilled with the ability to appropriately handle complexity and stress
- College courses in Business or Health Care Administration and/or Computer Technology preferred
- 1 year insurance/clerical experience within a hospital or medical office setting preferred
Company overview
Cape Fear Valley Health is a comprehensive regional healthcare system based in Fayetteville, North Carolina, serving southeastern North Carolina and surrounding regions. Established in 1956, it has grown to become North Carolina's 8th largest health system, operating as a private not-for-profit organization with 7,500 employees and over 1,000 physicians. The system encompasses eight hospitals with 988 total beds, including Cape Fear Valley Medical Center, Highsmith-Rainey Specialty Hospital, Bladen County Hospital, Hoke Hospital, and Harnett Health facilities. Annually, the system serves more than 1 million inpatient and outpatient visits across its network of over 150 locations. Cape Fear Valley Health specializes in cardiac care, cancer treatment, surgical services, neuroscience, pediatrics, rehabilitation, orthopedics, and behavioral health. The organization has earned numerous national recognitions including Healthgrades Top 100 Hospital for Cardiac Care, IBM Watson Top 50 Cardiovascular Hospital, and The Leapfrog Group Grade-A for Patient Safety. With a mission to provide exceptional healthcare for all patients, the system emphasizes patient-centered care, innovation, and community service while maintaining multiple disease-specific certifications from The Joint Commission.