Sr. Physician Services Specialist, Ortho,… at UC Health · Cincinnati

Administration:
•    Answers telephone and direct to correct person if needed.
•    Manages Outlook Calendar for providers within the clinic.
•    Manages office incoming mail.
•    Manages incoming communication related to case authorization. 
•    Validates registration information with patients and verifies all third-party payors (i.e. BWC, accident insurance, etc).
•    Engages in population appropriate communication.
•    Gives clear instructions to patients/family regarding treatment, diagnostic, procedural or surgical plan as directed by clinical team.
•    Monitors and coordinates timely follow up for planned diagnostic procedure based upon the standard of care. 
•    Prepares for upcoming clinics related to procedural planning.
•    Coordinate clinic template changes required to meet case and procedural obligations. 
•    Coordinates provider calendar related to faculty obligations. 
•    Performs in-basket management tasks. 
•    Coordinates completion of FMLA, Disability, BWC forms. 
•    Identifies and respond appropriately to different needs resulting from, unique psychological needs or those associated with religious / cultural norms.
•    Assists leadership with identification, training and orientation of new hires
•    Participates in process improvement initiatives.
•    Assists in development of department policies and SOPs

Scheduling:
•    Schedules and coordinates patient services, surgeries, tests, and other procedures as needed.
•    Coordinates all pre-procedural testing, diagnostic studies, medications, and other services as needed.
•    Communicates with patients via phone and in person regarding scheduling related matters.
•    Manages OR block time with providers Outlook calendar if applicable based on department guidelines.
•    Reviews and coordinate case changes identified with leadership related to urgency, case order, or unforeseen delays. 
•    Helps review daily schedules as needed and make leadership aware if changes are needed or discrepancies are identified.
•    Liaisons between staff and procedural areas for scheduling needs
•    Coordinates with all product or device representatives for cases
•    Completes complex coordination with co-surgeons in other surgical practices for joint case authorization and scheduling. 
•    Completes case request and referral order entry.

Data Management:
•    Performs audits on patient records/registration for insurance billing and compliance.
•    Reviews of office notes to ensure that all required items are noted for authorization request.
•    Performs pre-authorizations and pre-certifications utilizing care management protocols.
•    Utilizes payer portals to complete case, procedure, and visit authorizations. 
•    Coordinates peer to peer reviews for pending case authorization. 
•    Obtains CPT codes for all surgical and procedural cases and submit for authorization.
•    Obtains retro authorizations as needed.
•    Coordinates with utilization review for authorization status to avoid financial risk
•    Updates documentation in referral tab with all authorization updates 
•    Manage and audit assigned referral and authorization workques. 
•    Investigate patient satisfaction discrepancies and make recommendations to resolve and ensure future discrepancy is not repeated.

Other duties as assigned

Minimum Required: High School Diploma or GED. 

LICENSE & CERTIFICATION: None required. 

Minimum Required: 3 - 5 Years equivalent experience.