Imaging Patient Verification Specialist Job at Central Maine Healthcare
At Central Maine Healthcare our team members are committed to providing exceptional care and experiences for our community and for each other every day.
Position Summary:
Responsible for verification of appropriate orders for various Imaging procedures, including correct CPT codes, demographics, financials, and proper insurance information to include the presence of prior authorizations/ pre-certifications. Supports the appropriate coordination and scheduling of advanced interventional Imaging procedures for our Imaging Service lines. Works closely with the clinical Imaging Teams to include Radiologists, Technologists and RN’s to provide timely services and cohesive care. Verification duties also require proficiency in medical terminology, scheduling, pre and final registration, managing chart-preparation, charge reconciliation, and support pre-authorization process. Performs other various office tasks to include packaging oral contrast media, prescreening contrast media with pharmacy, transferring images into PACS network and uploading CD’s and reports. Provides guidance to the Patient Service Contact Center for scheduling routine diagnostic testing/procedures. Validates orders prior to procedures for accuracy working with the clinical teams as necessary. Provides support/guidance to patients, office staff, physicians and other providers.
Essential Duties:
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Subject matter expert related to advanced imaging procedures. Include but not limited to ensuring the prior authorization process is accurate and correct for procedures performed in in NM, CT, IR, XR, and US; verify interventional radiology and diagnostic radiology procedural orders are appropriately correlating with the clinical information and chart records; determination of IV contrast vs non contrast or both for CT procedures correlating the clinical information on the order and in the chart; ensures chart information is gathered for Invasive procedures (CT,IR, CT and US) prior to procedures with all appropriate forms in place; ensures PAT process is accurate and complete for procedures where PAT is necessary; submits orders back to providers/practices with appropriate recommendation when corrective action is required; ensure appropriate labs are order determined by the procedural types and maintains the schedule in a manner that assigns the appropriate resources (Radiologist, Imaging Technologist(s), RN(s)) for the correct time and type of procedural intervals.
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Verifies patient demographic accuracy via the patient chart to determine what registration information is needed from the patient at time of check-in after a pre-registration process is completed.
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Performs patient check-in process when deemed necessary following the appropriate registration processes.
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Verifies patient demographic records are accurate and up-to-date including patient name, address, date of injury, payer information, etc. by verifying existing information or entering updated data into the computer system.
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Verifies orders for “completeness” and returns them to ordering clinician if deemed incomplete under the guidance of the appropriate clinical team in Imaging.
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Prepares charts for visit/surgery by obtaining appropriate past documents, procedures, notes including operative notes, etc. for both internal and external requests for service
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Performs chart preparation includes printing labels, bracelets, and consent forms.
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Pre-screens each patient based against their procedure to include; checking medications, allergies, contrast requirements, securing lab results, securing prior studies.
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Plays an active role coordinating with pathology/lab, anesthesiology and nursing as required.
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Performs duties in the EMR, Scheduling program and PACS applications.
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Scans medical documentation and other required documents into electronic health record and/or PACS.
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Collects copays and outstanding balances at the time of service when performing front office duties.
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Utilizes electronic health record for messaging to/from clinical staff.
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Performs scheduling for advanced Medical Imaging procedures by entering patient information into the Scheduling System. Manages faxed referrals, phone and/or email.
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Ensures procedures scheduled follow the standard per clinical needs gaining support from Radiologists, Technologists and/or RN’s as needed.
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Manages service requests to ensure acted upon promptly.
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Verifies appropriate billing charges by assisting with charge reconciliation duties as defined by the Imaging Clerical Coordinator.
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Ensures compliance with hospital prior authorization requirements. This includes coordinating with the prior authorization unit as it relates to notifying of change in orders requiring modification to an authorization. Ensure prior authorization information is valid in advance of patient arrival.
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Performs insurance verification to ensure accurate billing to appropriate insurance for patient encounter(s).
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Maintains open communication with clinical staff to minimize interruptions to the team schedules.
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Verifies pre or post scheduling oversight relating to provider orders in the scheduling worklist to ensure they meet scheduling criteria, reason for test, test request, test order, diagnosis, key complaint, and signature. If not, reaches out to ordering office for new/updated order. Explains what order should/shouldn’t include or which test should be ordered. If order is external, order is reviewed after appointment is scheduled.
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Initiate scheduling activities including service, date, time, location and completing patient contact as required.
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Works No Show patients (update contrast prep, rescheduled, review prior auth needs, etc.)
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Identifies, flags errors, and corrects errors in schedule as identified and consistent with department and hospital guidelines.
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Provides support and oversight of Medical Imaging Schedule, and coordinates patient flow based upon availability and staff support, resolve conflicts.
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Professionally supports the PSCC (Patient Service Contact Center).
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Review each SDAN (Same Day Appointment Notification) paperwork (including med list, orders, etc.) for accuracy, missing or incorrect information and address with PSCC as appropriate.
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Preps SDAN for Radiologist to determine final contrast needs. If any changes, modifies appt and requests new authorization.
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Organizes and preps paperwork for the Imaging Team so they have all the necessary paperwork at their fingertips (nursing forms, med lists, orders, labels/wristbands, etc.).
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Fields questions and phone calls from CMMG/Inpatients/Radiologists/Technologists, RN’s/Schedulers etc.
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Reviews / responds to same day add-ons.
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Prep Contrast Packages- verify allergies, fax to pharmacy, complete label, bag and prepare for patient pick up.
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When supporting the front desk area ensures the waiting area is presentable. Notifies Facilities of any specific needs or concerns to ensure a pleasant and safe experience for all team members, visitors and patients. Collaborates with clinical staff and Imaging Leaders to answer all patient questions and concerns.
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Answers incoming internal and external calls.
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Manages incoming faxes and other documents
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Coordinates outside agencies to assist as Physician Educators to support credentialing of Radiologists.
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Opens and distributes daily mail. Assists with daily processing of office correspondence and distribution.
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Attends meetings, as assigned, and participates in educational activities to keep skills up to date
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Maintains patient confidentiality per State, Federal and company regulations.
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Strives to maintain positive patient relations by handling problems and complaints in a professional and confidential manner. Brings any patient concerns to Imaging Leadership.
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Keeps abreast of current issues involving patient care or departmental issues by attending and participating in department, team and practice meetings.
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Displays cooperative behavior and interacts positively and effectively with others to promote a team environment.
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Is proactive in identifying, reporting and participating in the resolution of any potential or actual patient safety issues.
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Maintains confidentiality.
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Performs other duties as assigned.
Education and Experience:
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Preferred Associates degree or equivalent years of experience or with two (2) or more years of experience in a similar role in health care organization/ environment.
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Knowledge of Imaging workflows, processes and requirements.
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Preferred Medical Terminology or Medical Coder background
Knowledge, Skills and Abilities:
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Excellent customer service skills
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Strong problem solving and analytical skills
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Ability to work independently and as part of a team
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Excellent communication and interpersonal skills, with the ability to interact with all internal and external customers in a professional and caring manner
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Proficient computer skills including Microsoft Office and email
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Excellent organizational skills with the ability to complete work in a timely, accurate and thorough manner
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Ability to engage patients and team members utilizing the CMH Experience StandardsI am creating a warming, caring, and non-judgmental environmentI am actively listening and seeking informationI am honest, truthful, and consistentI am respectful, treating all individuals with dignity and empathyI am serving as a role model, taking both initiative and ownership when appropriateI am working collaboratively and demonstrating teamworkI am resilient and adapt to change in positive ways.
If you are passionate about making a difference and are looking for your next great career opportunity, we look forward to reviewing your application!
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