Astera-OneOncology
Surgical Scheduler
We are looking for a Surgical Scheduler for our New Brunswick location. Responsible for collaborating with healthcare providers and members to optimize member benefits and to promote effective use of financial resources available. Assesses the medical necessity of surgical procedures and schedules according to practice expectations. Conducts pre-certification, concurrent and retrospective reviews to ensure compliance with medical policy, member eligibility, benefits, and patient's financial capability. Essential Duties & Responsibilities: Performs pre-certification and related duties to secure authorization for payment for surgical procedures from insurance companies, resources and patients and provide support for surgical scheduling. Review chart documentation to ensure patient meets medical policy guidelines Prioritize incoming authorization requests according to urgency Obtain authorization via payer website or by phone and follow up regularly on pending cases Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations Entry of benefits provided by the insurance representative in Centricity (practice management system) along with the contact's name and reference number for the call. Initiate appeals for denied authorizations Re-precertification of services, as necessary. It is the sole responsibility of this position to handle all assigned areas. Respond to clinic questions regarding payer medical policy guidelines Update Surgical trackers to ensure order and procedural reconciliation for both checking and authorizing Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order Contact patients to discuss authorization status Coordinate referral out for treatments if the situation dictates. Example: If the hospital is non-par for procedure but the provider is On Par. Precertification Specialist will itemize the out-of-pocket cost and inform patient. If the patient declines will defer to the surgeon on where to refer out to for procedure and continuation of care. Follow all policy and procedure set by Astera Cancer Care to correct any insurance issues before patient prior to patient's surgical date Coordinate Pre-Op teaching scheduling Coordinate for Medical clearance and Post Operative follow-ups with surgeon or advanced care provider Provide coverage for surgical scheduler in periods of staff shortages and scheduled time off. Assist with the coordination of surgical scheduling procedures at all locations as needed Other duties as assigned Communication with patients regarding deductibles and out of pocket costs. Patient responsibility will be calculated during benefits verification/Pre-certification process. Knowledge, Skills and Abilities: Knowledge of procedure authorization and its direct impact on the practice's revenue cycle Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively. Basic understanding of human anatomy, specifically breast surgical, medical oncology. Proficient use of CPT and ICD10 codes Excellent computer skills including Excel, Word, and internet use. Including but not limited to G4/Centricity, Flatiron/OncoEMR and insurance portals. Detail oriented with above average organizational skills. Plans and prioritizes to meet deadlines. Excellent customer service skills; communicates clearly and effectively. Role involves frequent interaction with all levels of staff, physicians, patients and insurance companies. Ability to multitask and remain focused while managing a high volume, time sensitive workload. Requirements: High School Diploma or equivalency 2-3 years experience in billing/coding/surgical scheduling Proficient in CPT and ICD-10 codes Experience in a surgical office setting Knowledgeable in Microsoft applications (Excel, Word, Powerpoint) College preferred We are proud to offer a comprehensive benefit package and paid time off. The health benefits include immediate eligibility for medical, dental, vision, life, disability, HSA, FSA and other ancillary benefits. We also offer a 401(k) plan with company contribution, profit sharing, tuition assistance and employee referral bonus.
We are looking for a Surgical Scheduler for our New Brunswick location. Responsible for collaborating with healthcare providers and members to optimize member benefits and to promote effective use of financial resources available. Assesses the medical necessity of surgical procedures and schedules according to practice expectations. Conducts pre-certification, concurrent and retrospective reviews to ensure compliance with medical policy, member eligibility, benefits, and patient's financial capability. Essential Duties & Responsibilities: Performs pre-certification and related duties to secure authorization for payment for surgical procedures from insurance companies, resources and patients and provide support for surgical scheduling. Review chart documentation to ensure patient meets medical policy guidelines Prioritize incoming authorization requests according to urgency Obtain authorization via payer website or by phone and follow up regularly on pending cases Maintain individual payer files to include up to date requirements needed to successfully obtain authorizations Entry of benefits provided by the insurance representative in Centricity (practice management system) along with the contact's name and reference number for the call. Initiate appeals for denied authorizations Re-precertification of services, as necessary. It is the sole responsibility of this position to handle all assigned areas. Respond to clinic questions regarding payer medical policy guidelines Update Surgical trackers to ensure order and procedural reconciliation for both checking and authorizing Confirm accuracy of CPT and ICD-10 diagnoses in the procedure order Contact patients to discuss authorization status Coordinate referral out for treatments if the situation dictates. Example: If the hospital is non-par for procedure but the provider is On Par. Precertification Specialist will itemize the out-of-pocket cost and inform patient. If the patient declines will defer to the surgeon on where to refer out to for procedure and continuation of care. Follow all policy and procedure set by Astera Cancer Care to correct any insurance issues before patient prior to patient's surgical date Coordinate Pre-Op teaching scheduling Coordinate for Medical clearance and Post Operative follow-ups with surgeon or advanced care provider Provide coverage for surgical scheduler in periods of staff shortages and scheduled time off. Assist with the coordination of surgical scheduling procedures at all locations as needed Other duties as assigned Communication with patients regarding deductibles and out of pocket costs. Patient responsibility will be calculated during benefits verification/Pre-certification process. Knowledge, Skills and Abilities: Knowledge of procedure authorization and its direct impact on the practice's revenue cycle Understanding of payer medical policy guidelines while utilizing these guidelines to manage authorizations effectively. Basic understanding of human anatomy, specifically breast surgical, medical oncology. Proficient use of CPT and ICD10 codes Excellent computer skills including Excel, Word, and internet use. Including but not limited to G4/Centricity, Flatiron/OncoEMR and insurance portals. Detail oriented with above average organizational skills. Plans and prioritizes to meet deadlines. Excellent customer service skills; communicates clearly and effectively. Role involves frequent interaction with all levels of staff, physicians, patients and insurance companies. Ability to multitask and remain focused while managing a high volume, time sensitive workload. Requirements: High School Diploma or equivalency 2-3 years experience in billing/coding/surgical scheduling Proficient in CPT and ICD-10 codes Experience in a surgical office setting Knowledgeable in Microsoft applications (Excel, Word, Powerpoint) College preferred We are proud to offer a comprehensive benefit package and paid time off. The health benefits include immediate eligibility for medical, dental, vision, life, disability, HSA, FSA and other ancillary benefits. We also offer a 401(k) plan with company contribution, profit sharing, tuition assistance and employee referral bonus.