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BH Scheduling/Pre-Cert Coord

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POST DATE 7/17/2019
END DATE 11/23/2019

The Children's Hospital of Philadelphia Philadelphia, PA

Philadelphia, PA
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Entry Level (0 - 2 years)
High School Diploma or GED


BUERGER - Buerger Center Ambulatory Care Req ID: 26929

Shift: Any

Employment Status: AF - Active - Regular - Full Time JOB SUMMARY

Responsible for coordinating appointment scheduling, from initial referral to a scheduled appointment for the patient with the department providers, with emphasis on financial coordination for families. Also responsible for managing insurance coverage issues for patients seeking Behavioral Health outpatient or Day Hospital services. Liaison with the Access Center, external and divisional providers to ensure patients and families needs are met and complete multiple tasks to ensure that patients have all necessary steps in place by the time of the appointment. Provide support to assigned providers and customer service to families and referring providers. JOB RESPONSIBILITIES

Manage Phone Calls

* Answer telephones, screen and route callers, take messages and provide information to callers promptly and courteously.

* Document all phone conversations and follow-up phone calls in Epic.

* Participate in handling urgent calls and hand off to clinician or manager.

* Serve as the first resource between Family and Department.

Schedule Initial and follow up appointments as needed

* Screen patients at initial contact for appropriateness of clinical service, helping facilitate when families need to be redirected for care elsewhere at CHOP.

* If patient is appropriate for service, document intake, communicate process to families, schedule the patient for appointment and mail or electronically send clinical assessments to be completed by the family and/or school personnel and follow-up with family to retrieve any documents necessary for prior to the appointment.

* Maintain Recall tracking system for patients needing to be seen as a follow-up via EPIC; run monthly reports of recalls, and contact families for recall appointments, following the scheduling guidelines outlined by the department.

* Maintain referral tracking process, triage patient and determine provider to be seen, update tracking work queue daily, to reflect appointment completion status.

* Maintain a waitlist tracking system via EPIC and keep a log of patients who can fill last minute cancellations with a few days notice.

* Problem solve barriers to patient appointment access through collaborative efforts with Operations Manager, providers, and other staff.

* Assist other staff members with scheduling, insurance authorizations/verifications, and phone as requested.

Obtain Insurance Authorizations and Verifications

* Utilize databases (Navinet,etc.) and/or calls insurance payors to obtain detailed patient insurance benefit information for all aspects of the behavioral health treatment process, including maximum insurance benefit restrictions.

* Create and/or update patient record by verifying demographic, insurance information, and correct guarantor for Behavioral Health is in the registration system, complete daily scrub of the DAR to ensure that all benefit information is complete by the time of the appointment.

* Obtain the Mental Health insurance verification and medical benefit authorization with regard to behavioral health services, including benefits for evaluation, treatment, testing, and follow up.

* Inform family of financial responsibility for BH evaluation and treatment related to insurance authorization to clinicians, families, and clinical leadership. Where a specific pre-authorization is required, obtains that pre-authorization from the insurance company.

* Communicate benefits and other inpatient/outpatient related financial issues with parents, families and providers.

* Work with Manager to establish proper procedures for coverage verification and authorization for evaluation and follow up appointments.


Requests for Medical Records

* Obtain medical charts in response to urgent provider requests (e.g., chart needed immediately for phone call). For routine requests, providers should go through Department Medical records area directly.

* Facilitate obtaining HIPAA release from parents/patients when they call the coordinator with a request for records. Instruct caller to forward HIPAA release form to DCAPBS MR, Medical record staff will work with the provider on what to release, and will copy and mail/fax the information as directed.

Keep Provider EPIC schedules up to date

* Build provider templates for scheduling and update the template to reflect any time off, unavailable time, Holidays, and any changes to the template as requested by the provider.

* Ensure that provider appointments are filled up to 80%, in advance depending on patient volume and length of waitlist.

* Review provider schedules proactively to identify unscheduled appointment slots and initiate contact with families to successfully fill all appointments.


Required Education: High School/GED

Required Experience:

* Minimum of 5 years of related experience required, with at least 6 months experience/knowledge obtaining benefit information from various payors

* Experience with Navinet, Passport, etc.


Preferred Education: Associates

Preferred Experience: Experience with computers, Electronic Medical Record experience preferred. Customer service background in an outpatient healthcare setting ADDITIONAL TECHNICAL REQUIREMENTS

* Strong ability to multi-task a high patient volume and meet deadlines

* Ability to handle confidential materials and matters.

* Knowledge of Microsoft Office preferred.

* Excellent screening skills to determine acuity if there is a need to consult clinical colleagues for guidance.

* Position involves contact with families and professionals, particularly by telephones, which requires a pleasant telephone manner and ability to respond to complex and pressured situations efficiently and accurately.

* High level of interpersonal skills with excellent customer service and responsiveness.

* Strong and empathetic listening skills.

* Ability to learn/understand/communicate insurance issues when relevant.

* Strong communication skills. Ability to clearly explain scheduling options to families and providers.

* Strong collaboration and teamwork skills.

* Attention to detail and strong organizational skills.

All CHOP employees who work in a patient building or who provide patient care are required to receive an annual influenza vaccine unless they are granted a medical or religious exemption.

Children\'s Hospital of Philadelphia is committed to providing a safe and healthy environment for its patients, family members, visitors and employees. In an effort to achieve this goal, employment at Children\'s Hospital of Philadelphia, other than for positions with regularly scheduled hours in New Jersey, is contingent upon an attestation that the job applicant does not use tobacco products or nicotine in any form and a negative nicotine screen (the latter occurs after a job offer).

Children\'s Hospital of Philadelphia is an equal opportunity employer. We do not discriminate on the basis of race, color, gender, gender identity, sexual orientation, age, religion, national or ethnic origin, disability or protected veteran status.

VEVRAA Federal Contractor/Seeking priority referrals for protected veterans. Please contact our hiring official with any referrals or questions.

CHOP Careers Contact

Talent Acquisition

2716 South Street, 6th Floor

Philadelphia, PA 19146

Phone: 866-820-9288