Surgery Scheduler / Billing Coordinator

POSITION SUMMARY: Responsible for coordinating the surgery schedules for OB/GYN providers and managing the prior authorization process for procedures ordered or performed. Communicates and establishes payment arrangements for self-pay patients, and performs all billing related functions (e.g., charge and payment posting). Procedures range from obstetric ultrasounds, surgery performed at Barnes-Jewish Hospital, and in-office procedures.

POSITION QUALIFICATION REQUIREMENTS

Education: High School graduate or equivalent. Billing school certification preferred.

Experience:

1. One to three years' experience in healthcare related area
2. Must be experienced in prior authorization process/management
3. Working knowledge of CPT, HCPCS and ICD-9 coding

Skills and Abilities which may be representative but not all inclusive of those commonly associated with this position:

1. Knowledge of health insurance terminology and billing process
2. Knowledge of Medicaid, Medicare and 3rd party payer requirements
3. Possess excellent written and verbal communications skills
4. Possess excellent investigative skills
5. Proficient in using Microsoft Outlook, Excel and Word with typing speed of 45 wpm
6. Able to multi-task, establish priorities, and work independently
7. Experience with NextGen EMR and EPM a plus
8. Customer Service focused

Transportation Requirement: Must possess a valid driver's license and automobile with insurance coverage as required by the State of Missouri.

License(s)/Certification(s) Required:

Certified Application Counselor for Medicaid, Gateway to Better Health and Health Insurance Marketplace

FUNCTIONS OF THE JOB

Essential Functions

1. Coordinate each OB/Gyns and RNPs surgical schedule by establishing procedures developed in conjunction with the providers.
2. Communicate with patients, hospital staff, providers, and payers to ensure all arrangements are complete.
3. Determine insurance coverage and establish payment arrangements as needed for patients for services provided at Grace Hill and for ancillary services.
4. Review case and insurance notes to determine steps required to obtain a prior authorization.
5. Call and follow-up with payers to obtain a prior authorization or pre-determination by providing the payer representatives with an overview of the services in which coverage is being requested.
6. Obtain, complete, and submit special forms and/or medical records when required by the payer.
7. Complete assigned work list tasks in a timely manner and/or report to management when assistance is needed to complete the tasks.
8. Post charges and payments (manual and electronic) received for all OB/GYN providers in a timely (within two (2) days of receipt) and accurate manner including deliveries performed by Washington University providers.
9. Review invoices received from Washington University for accuracy and submit to Director for approval and payment.
10. Maintain patient health information (PHI) in compliance with HIPAA.
11. Participate in meetings and undertake special projects as assigned.

Marginal Functions:

Assists in audits.

Provide backup support to billing department staff as needed.

Supervises: None

NOTE: Affinia Healthcare is a Covid-19 Vaccine Mandated Employer. All employees of Affinia Healthcare are required to be vaccinated for Covid-19.

NOTE: SMOKING IS PROHIBITED IN THE WORK ENVIRONMENT

NOTE: ALL APPLICANTS MUST PROVIDE CONTACT INFORMATION FOR THREE REFERENCES

AN EQUAL OPPORTUNITY SERVICES PROVIDED ON A NON-DISCRIMINATORY BASIS

Current Openings for Surgery Scheduler / Billing Coordinator Jobs at Affinia Healthcare