Pre-Service Specialist

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POST DATE 9/2/2016
END DATE 10/14/2016

Northwestern Memorial Healthcare Chicago, IL

Company
Northwestern Memorial Healthcare
Job Classification
Full Time
Company Ref #
0014004
AJE Ref #
576067373
Location
Chicago, IL
Experience
Entry Level (0 - 2 years)
Job Type
Regular
Education
High School Diploma or GED

JOB DESCRIPTION

Scheduling and registration functions, although currently completed in two systems are duties which are essential prior to the patients visit to Northwestern Memorial Hospital. Some of these specific duties are outlined below, the objective is to carefully plan for all components of the patients visit prior to their arrival. Those components include: Scheduling, location of test, date and time confirmation, pre-procedure instructions order expectation, financial responsibility of the patient and financial programs available to the patient from NMH. Primary Responsibilities include: Politely and promptly answers and appropriately triages department telephone calls. Correctly identifies and collects patient demographic information in accordance with hospital standards. Schedules appointment in centralized scheduling system, in accordance with patients First service standards using scripted language for greeting the caller, reviewing the scheduling activity and summarizing the transaction at the end of the call. Consistently practices Best Patient Experience philosophy and adheres to high standards of customer service. This includes setting an example to peers, coworkers, etc. by fostering a team atmosphere. Is proactive in preventing issues with patient visit by double checking type of test, preps required, assuring no conflict with other tests, verifying time and location, communicating NMH environment (parking, directions) and documenting order retrieval in notes for check-in person. Communicates information to the patient regarding questions about physician referrals, insurance referrals and consultations. Collects Authorization numbers in Cadence as applicable. Interacts with various hospital departments and physicians offices to effectively schedule and direct patients through the NMH system in a patient/customer friendly manner. Utilizes online order retrieval systems to verify or print the patients order: EPIC, Chartview, alpha file, fax server. Reach out to patients to schedule an appointment, when necessary (NMPG, CPM, Erie Family Health, Urgent Requests). When necessary, requests interpreter services for patients visit with Patient Representative Department. Utilizes the language line of the hospital to schedule patients who require interpretation service. Understands minimum data set required for a complete registration, collects and verifies critical data and updates that information into registration system. Understands departmental and individual quality metrics, including abandonment rates, average answer delay, RONA, AIDET scorecard, quality reviews, and not ready %. Utilizes daily printed reports for self-monitoring. Performs medical necessity checks for scheduled services, communicates options to patient if appointment fails. Documents (when necessary) account notes in scheduling and registration systems. Identifies and works to minimize potential financial risk of patient accounts through financial reports, systems information or direct contact. Assesses and communicates coverage limitations and payment expectations when reimbursement is not in compliance with specific NMH contracts. Proactively analyzes account activity, identifies problems, and initiates appropriate actions/resolutions. Responds to questions and concerns. Forwards, directs and notifies of extraordinary issues as necessary. Evaluates procedures and suggests improvements to enhance customer service and operational efficiency. Verifies insurance eligibility and benefit levels through the use of online clearinghouse tools (NDAS, ASF, etc.) or over the phone as necessary. Facilitates the pre-authorization of diagnostic exams, between referring physicians and insurance carriers, through the use of online tools, worklists, and direct phone calls as necessary. Ensures that outpatient procedures have a valid ICD-9 code, and that for Medicare patients, medical necessity has been met. Communicates with physician offices to troubleshoot failing medical necessity for Medicare patients. Informs patients of any issues with securing the financial account for their encounter. Completes other duties assigned by manager. Cross-training between various departments may take place to ensure coverage. Secondary Responsibilities: Provides professional and constructive environment for communication across units/departments and resolves operational issues. May attend intra/interdepartmental meetings which involve walking within NM Campus. Develops staff understanding of departmental and NMH performance standards, goals, policies and procedures. Provides necessary coaching and feedback. Provides training and education as needed. AA/EOE.

Required: High School Diploma, 1-2 years customer service experience, Proficient in typing.



Desired: Bachelor's degree, Healthcare Finance and/or Healthcare Insurance Knowledge, Experience in a healthcare setting, especially patient scheduling and/or registration, Coding Certification, Certified Healthcare Associate Designation (NAHAM).