Specialty Procedure Coord - PN

Overview

Lexington Brain & Spine Institute

PRN
• Day Shift
• varied

Lexington Health is a comprehensive network of care that includes six community medical and urgent care centers, nearly 80 physician practices, more than 9,000 health care professionals and Lexington Medical Center, a 607-bed teaching hospital in West Columbia, South Carolina. It was selected by Modern Healthcare as one of the Best Places to Work in Healthcare and was first in the state to achieve Magnet with Distinction status for excellence in nursing care.

Consistently ranked as best in the Columbia Metro area by U.S. News & World Report, Lexington Health delivers more than 4,000 babies each year, performs more than 34,000 surgeries annually and is the region's third largest employer. Lexington Health also includes an accredited Cancer Center of Excellence, the state’s first Heart

CARE Center, the largest skilled nursing facility in the Carolinas, and an Alzheimer’s care center. Its postgraduate medical education programs include family medicine and transitional year residencies, as well as an informatics fellowship.

Serves as a liaison between the patient, insurance company, internal staff, and outside offices to manage and obtain all pre-requisites and prior authorizations for specialty-specific procedures or surgeries while being the gatekeeper for the final decision of procedure/surgery being scheduled to ensure reimbursement will be received. Coordinates with clinical team to address concerns in patient’s preparation for procedure/surgery. Responsible for overall data collection, reporting of case volume, and other metrics for programmatic initiatives as well as identification of trends and potential concerns such as insurance denials.

Minimum Education
:
High School Diploma or Equivalent

Minimum Years of Experience
: 6 months of scheduling, referral and/or authorization experience in a healthcare setting

Substitutable Education & Experience
:
None.

Required Certifications/Licensure
:
None.

Required Training
:
Familiar with medical terminology, procedures, and coding;
Extensive knowledge of guidelines required for medical record documentation;
Must be computer literate with extensive knowledge of computer systems, including EHR and MS Applications.

• Works independently as well as closely with members of the multidisciplinary team including but not limited to the surgeons, practice leadership, and quality/programmatic coordinators.
• Responsible for assisting patients with benefit coordination to assure the appropriate insurance prerequisites are completed in a timely manner. Responsible for collection of pre-payment for procedures/surgeries when applicable.
• Tracks and trends insurance requirements to identify potential issues and act to resolve those problems quickly. Works collaboratively with physicians and managers regarding updating and modifying program pathways to maintain or increase the effectiveness in reimbursement rates, billing and collection.
• Serves as a liaison between patients, other medical providers, other clinical departments, front business office, and insurance companies regarding authorizations for procedure/surgery.
• Obtains and verifies appropriate documentation from payers to establish coordination for clean claims. Maintains all informational material received from insurance companies.
• Stays current on all program requirements and medical necessity requirements in order to provide assistance and guidance to leadership on reimbursement-related matters regarding procedure/surgery requirements.
• Assists in research and follow-up on all denials, claim corrections, and rejections related to procedure/surgery reimbursement.
• In collaboration with practice/program leadership, oversees and coordinates team meetings that bring a multidisciplinary approach to address any concern with the surgical patient experience.

• Provides education to patients, surgeons and all staff regarding pre-requisites for procedure/surgery as well as the appeal process.
• Demonstrates knowledge of commercial, Medicaid, Medicare, Workers' Compensation, all contractual…