Pre-Authorization Scheduling Coord.

WVU Medicine; Keyser (WV); On-site; USD 36,000 - 42,000; Full time

Job summary

PVH Potomac Valley Hospital is seeking a Scheduling & Registration Coordinator to manage the scheduling of outpatient procedures, collect accurate patient data, and coordinate care across departments. The role emphasizes courteous communication, attention to detail, and efficient data entry for billing and insurance verification.

Responsibilities include handling multi-step scheduling, providing clear instructions to patients, and supporting the billing team in resolving claims.

Qualifications

• High school diploma or equivalent required; one year of recent scheduling/registration or business office experience is needed.
• MA degree or Associate Degree acceptable.
• Familiarity with insurance verification and healthcare coding helps.

Responsibilities

• Schedule outpatient procedures by phone with patients and offices in a courteous, professional manner.
• Coordinate multiple procedures to ensure same-day scheduling within a reasonable timeframe.
• Obtain and enter demographic, billing, and insurance data into scheduling and billing systems.
• Verify insurance and pre-cert/pre-auth information; complete Medicare Secondary Payer forms when applicable.
• Assist billing with researching and resolving denied claims as needed.
• Maintain scheduling/registration accuracy and complete required documentation.

Skills

Communication skills

Customer service

Telephone etiquette

Keyboard/mouse/computer use

Insurance verification knowledge

Healthcare coding basics

Admissions/registration experience

Education

High school diploma or equivalent

Medical Assistant (MA) degree

Associate Degree

Tools

Office equipment

Job description

Receives physician and patient communications to schedule patients and manages the registration process. Responsible for accurate and timely interviewing of patients and/or relative in a courteous manner to obtain registration data based upon comprehensive data elements to complete the registration process.

MINIMUM QUALIFICATIONS

EDUCATION, CERTIFICATION, EXPERIENCE, AND/OR LICENSURE

• High school diploma or equivalent required AND One year of recent experience in a physician/hospital scheduling and registration or business office environment OR;

Completed Medical Assistant (MA) degree OR;

Associate Degree.

CORE DUTIES AND RESPONSIBILITIES

• May be scheduled to work various shifts based on departmental and patient needs.
• Schedules outpatient procedures via telephone with patients and offices in a courteous, professional manner.
• Coordinates multiple procedures patients have to ensure they are scheduled on the same day and within an appropriate time frame.
• Provide patients and offices with accurate instructions regarding the schedule procedure (i.e., NPO, arrival time, where to arrive, etc.).
• Check order documents for completeness. Validate orders against scheduled services.
• Clearly documents activities and actions take on accounts, which include but not limited to, authorization, communication with patients, staff and other departments.
• Maintains scheduling and registration accuracy threshold of 95% as identified in audit processing.
• Perform prior authorization process by performing medical review and entering authorizations into system.
• Works and assists with the billing department in researching and resolving rejected, incorrectly paid, and denied claims as requested.
• Ability to multi task and perform duties well; while under pressure; while meeting deadlines.
• Obtains demographic/billing/insurance information from patient/family/legal guardian and correctly enters into the scheduling and registration/billing systems for service and claim processing.
• Understand and use applicable CPT and ICD-9 codes.
• Verify insurance; validate pre-cert/pre-auth information after completion of insurance verification and record results in system. Preforms other insurance related functions as required or necessary.
• Completes Medicare Secondary Payer forms, where applicable. Completes medical necessity screening. Verify medical necessity for applicable payer and service.
• Cancel or reschedule patients in accordance with hospital workflows.
• Exercises proper stewardship through the appropriate us of supplies, equipment, and time.
• Follows hospital, state and federal guidelines for ensuring safe environment for workers, patients and public. Ensures compliance by staff to hospital, governmental and insurance regulations.
• Actively participates in in-services, staff meetings, continuing education courses, hospital wide committees and other meetings as needed or required.
• Participates in the processes to assess and improve the services provided and compliance with regulatory requirements. Reports results assessment and improvement processes to the appropriate administrative level.
• Performs other duties as assigned which support the mission and values of the organization. Willingly accepts assignments within scope of practice, skill set and level of competence.

PHYSICAL REQUIREMENTS

• Must meet Department of Labor’s MEDIUM duty standard (MEDIUM WORK- exerting up to 50 pounds of force occasionally, and/or up to 20 pounds of force frequently, and/or up to 10 pounds of force constantly).
• Able to bend, stoop, reach and be capable of normal rotation, standing and walking for an 8-10 hour shift.

WORKING ENVIRONMENT

• May be required to travel between facilities/buildings.

SKILLS AND ABILITIES

• Strong communication skills. Working knowledge of office equipment and computers.
• Excellent customer service and telephone etiquette. Must demonstrate the ability to use tact and diplomacy in dealing with other.
• Use a computer keyboard, monitor and mouse. Answer telephones and transcribe messages. Communicate verbally, written and electronically with healthcare personnel, families and patients.
• Working knowledge of healthcare insurance plans.
• Working knowledge of hospital clinical departments and service protocols.
• General knowledge of hospital payment plan guideline.
• General knowledge of healthcare coding practices.
• General knowledge of hospital clinical departments and services protocols.
• Experience and knowledge in admissions, registration, and insurance verification.

Additional Job Description

Scheduled Weekly Hours

40

Shift

Exempt/Non-Exempt

United States of America (Non-Exempt)

Company

PVH Potomac Valley Hospital

Cost Center

550 PVH Scheduling Call Center

Address

100 Pin Oak Lane

Keyser

West Virginia

Equal Opportunity Employer

West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.