Authorization, Pre -Cert, Scheduler
Under the direction of the Site Manager, the Scheduler, Referral, Precertification Coordinator processes all requests received via fax, CPOE, and verifies member eligibility, including checking Practice Plus eligibility. Ascertains benefit availability and creates all events in Athena EMR by responding to request per CRMG workflows. Is responsible for notifying requesting providers if the member has terminated coverage, any problems with referrals, or scheduling procedures or tests. Coordinates with the physician in the provision of care, out-patient services provided to minimize the process steps necessary for physician to achieve access for their patient. Assuring that the appropriate payers' have been identified and payers' requirements have been met. Prior authorizing by an insurance company approving the medical necessity of the procedure. Improve the relationship between the hospitals, physician by assuming this responsibility. Education of physician and team members about regulatory and process requirements.