REHAB SCHEDULING & AUTHORIZATION SPEC

General Purpose of Job:

This role is responsible for obtaining and processing incoming/internal and outgoing referrals including scheduling and coordinating resources for patient appointments and procedures for multidisciplinary clinics. Responsible for obtaining financial authorization prior to services being received. The Rehab Scheduling and Authorization Specialist works closely with the OP Rehab Manager and other team members to ensure patients are being evaluated in a timely manner and have insurance authorization. The accuracy of these tasks will ensure the patient is scheduled for the accurate clinic/provider, ensure authorization for high revenue services and secure payment for the health system.

Essential Duties:

This job description is intended to cover the minimum essential duties assigned on a regular basis. Associates may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position.

• Communicates with patients to schedule and register appointments.
• Coordinates care with scheduling and therapy team members to promote efficient care for patients.
• Communicates within the team any unplanned schedule interruptions.
• Assess patient treatment and therapy plans to determine authorization requirements.
• Understands with working knowledge of payer requirements for obtaining authorizations.
• Develops relationships with clinical staff to secure payment for services related to patients' appointments, therapy, and treatment plans.
• Responsible for providing all required medical information to insurance companies as necessary to facilitate authorization or referral process.
• Assists in educating and acts as a resource to clinicians and support staff regarding authorizations or referrals.
• Follow up on insurance determination within specified time frames.
• Coordinates resolution of escalated member or provider inquires as related to prior authorization, referral, or denial of authorization.
• Communicates to clinicians or other medical staff regarding referral and prior authorization especially if a medical procedure has been denied.
• Works with operations to determine insurance requirements for medical necessity.
• Verify insurance eligibility and covered benefits by using all electronic systems available or by phone. Process knowledge of financial class requirements regarding registration and insurance requirements.
• Educate the patient as to their path for the referral process and financial responsibility.
• Operate multiple computer applications to register patients, retrieve insurance, financial information and review medical records.
• Seek ways to continually improve the value of our services and maximize our customers' rehabilitation potential by actively participating in activities such as in-services, staff meetings, team meetings, and continuing education courses.
• Maximize customer satisfaction by treating our customers with respect and responding to their needs in a prompt, friendly, and courteous manner
• Assists leadership and supports program operations as assigned.
• Answer all incoming, outgoing, and inter-hospital phone call using AIDET. Relays information to proper party, takes messages, contacts necessary person, and answers inquiries.