Patient Financial Specialist II - Maternal Fetal Medicine

Employment Type:

Full time

Shift:

Day Shift

Description:At Mount Carmel, we work to continuously inspire one another. Here, all are welcome. It is this culture of humility and compassion that sets Mount Carmel apart. We see the big picture and do the right thing. That means a dedication to the well-being our both our colleagues and the patients they serve.

Excellence in care takes the dedication and commitment of not only our front-line care teams, but of the specialized professionals that support all aspects of our mission. Colleagues in Finance, HR, Marketing and more keep Mount Carmel operating at the highest standard. And we provide leading education training and development opportunities to keep you working at yours.

The Patient Financial Specialist II performs all the functions of a PFS I. In addition, the PFS II performs verification of prior authorization and obtaining precertification for selected scheduled services. Also, this staff member is proficient in scheduling complex procedures from the physician’s office as well as complex and changing insurance/reimbursement requirements.

Responsibilities

• Performs activities that relate to patient scheduling, pre-registration, real-time eligibility verification, medical order processing, medical necessity review (LMRP/LCD review), dissemination of patient information, and support coverage of other intra-departmental functions.
• Determines proper scheduling requirements and/or limitations according to requested test(s)/procedure(s) and schedules resources (equipment, staff, room, and etc.) in a timely manner to ensure customer satisfaction, maintain patient flow, and appropriate utilization of the service area. Coordinates add-on and same-day appointments with the service area, as required. Ensures proper test sequencing with minimal patient delays when multiple testing is required.
• Provides patient, family and physician office education during scheduling process to inform them of preparations needed for diagnostic testing and proper scheduling instructions. Communicates with various ancillary departments to ensure an accurate schedule and that all reports are properly distributed.
• Validates medical necessity (LMRP/LCD review) of Medicare and Non-Medicare cases to ensure clinical and financial clearance. Contacts physicians/office staff for clarification, if cases require clarification of diagnosis and/or test(s)/procedure(s)

Requirements/Qualifications

• High School Diploma
• Working knowledge of medical terminology, and data entry skills. Past work experience of at least two (4) years within a physician office, hospital or clinic environment, performing patient scheduling and precertification activities is highly desired
• Proven experience in 2 of the 4 following areas: Web and fax orders, Outpatient IV scheduling, Complex physician office scheduling such as Wound care and physician performed procedures, or Precertification.
• Excellent interpersonal skills are necessary in dealing with peers, internal, and external customers. Accuracy, attentiveness to detail and time management skills are required.

Discovering opportunities, support and excellence – all while making a real difference in patients’ lives – begins at Mount Carmel. Find a new beginning and advance your career with us.

Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, sexual orientation or physical ability.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.