Authorization and Scheduling Specialist -… at Muscogee… · Tulsa

MINIMUM QUALIFICATIONS

Education – Incumbent must be a current licensure as a Licensed Practical Nurse or Certified Surgical Technologist in good standing with the State of Oklahoma.

Experience - One year of relevant Operating Room, Pre-admission, or Surgery scheduling preferred.

Licenses & Certification – Incumbent is required to possess current licensure by the State of Oklahoma or National Council of State Boards of Nursing for Practical Nurse or current certification by the National Board of Surgical Technology and Surgical Assisting. Must possess Current BLS. If LPN, must obtain ACLS and PALS certifications within 6 months of hire.

Knowledge & Skills –

1. Knowledge of general medical terminology and of the terminology used in the process of billing for medical services.
2. Knowledge of Electronic Health Record (EHR) system and the ability to correctly enter data into the EHR, EPIC strongly preferred.
3. Knowledge of patient scheduling and registration procedures in an ambulatory and/or non-ambulatory clinic.
4. Ability to maintain strict confidentiality with regard to patient health information.
5. Skill in utilizing a personal computer and its applications in a Windows environment and the ability to organize, file and retrieve information.
6. Ability to communicate courteously and effectively with patients and their families, MCNDH staff and the general public for the purpose of supplying or obtaining information.
7. Knowledge of third party and other numerous alternate resources used in the billing of medical services.
8. Ability to maintain a professional demeanor.
9. Professional knowledge of nursing care principles, TQM ethics, practices and processes required to assess nursing needs of assigned patients.
10. Knowledge of wide variety of medical disorders, normal course of diseases, potential complications and individual therapeutic interventions.
11. Knowledge of pharmaceuticals, their desired effects, side effects and complications of their use.
12. Ability to recognize and react to emergency situations.
13. Knowledge and skill in operation and monitoring of general nursing equipment; e.g. infusion pumps, defibrillators, arrhythmia monitors, etc.
14. Ability to develop, implement and evaluate a patient care plan to meet the need of assigned patients.
15. The ability to respond quickly and accurately to changes in patient and or unit conditions.
16. Knowledge and skill of collection laboratory specimens such as wound cultures, procedure pathology, and urine.

JOB SUMMARY

The purpose of this position is to perform clerical duties and obtain authorization of services prior to procedure and schedule services as ordered. Incumbent interviews patient or patient’s representatives to obtain pertinent data and information for insurance and billing purposes, updating records, data entry, etc. The incumbent will also

provide nursing/technologist services and support to the Muscogee (Creek) Nation Department of Health operating rooms and outpatient surgery. The incumbent will consistently display behavior that enhances the image of the health care system as evidenced by professional and courteous behavior toward all customers and co-workers.

WORK ENVIRONMENT

Work is performed in a hospital setting. There is common exposure to infectious communicable diseases, potentially hazardous chemicals and bio hazardous materials. The work may include a certain amount of exposure to hostile and emotionally disturbed patients, families and visitors. Must be aware of all risks involved and be willing to take precautions as requested and required.

PHYSICAL DEMANDS

Work in a hospital setting requires considerable walking between work stations and patient care areas. Work will require being seated for long periods of time, entering data and telephone usage. Work will also requires regular and recurring bending, stooping, stretching, and lifting of patients or similar activities. Incumbent must be able to lift at least 50 pounds. Position also requires ability to cope with constant changes in a stress-laden environment.

ESSENTIAL FUNCTIONS

Satisfactory job performance will be determined by successful execution of the following:

1. Completes surgery scheduling in the electronic medical record from all resources, keeping an open line of communication between all parties.
2. Answers daily inquiries of patients and public in person or via telephone regarding registration procedures, hospital regulations and services. When necessary, refers inquirers to appropriate personnel or department elsewhere in the hospital.
3. Interview incoming patients or representatives to include necessary information for obtaining prior authorization for services provided, scheduling, admission or registration.
4. Works with insurance companies to obtain necessary prior authorizations as required for services provided.
5. Maintains a high level of understanding of insurance companies and authorization/referral requirements.
6. Ensure insurance carrier documentation requirements are met, documented and scanned in patient medical chart as required.
7. Maintains an approachable and appropriate attitude when interacting with all levels of personnel in a rapidly changing environment.
8. Explains necessary hospital rules and regulation to incoming patients.
9. Responsible for completing job duties in a timely manner and ensure material is correct and accurate. Completes routine tasks as required and consult the Insurance Authorization and Scheduling Team Lead for guidance in processing tasks.
10. Schedules and completes pre-admission testing of surgical patients, and documents in the electronic medical record. Including ordering of labs, radiology test and other tasks as needed.
11. Provides for emotional support, physical comforts, and safety of patients. Assists with all activities of daily living and personal care needs.
12. Observes, records, and reports signs, symptoms and responses of patient change in condition or reaction to treatments to the appropriate persons.
13. Performs simple lab tests such as stool checks for blood and finger stick blood sugars.
14. Obtains screening and admitting information and documents information correctly.
15. Provides first-aid and emergency care as well as provides for resuscitation procedures in cardiac and/or respiratory arrest as well as assisting with disaster measures as needed.
16. Teaches patients and family members the maintenance of health and the prevention of disease. Emphasizes physician’s directions and instructions on self-care and procedures. Ensures that patient and/or family member understands instructions.
17. Shares responsibility in ensuring that the hospital has adequate supplies and equipment, a safe environment is maintained and general upkeep of the facility is done on a continual basis.
18. Attends at least 75% of department staff meetings.
19. Regular attendance is required.
20. Performs other duties as assigned, up to and including routine patient care in pre-admission and post-surgical units.