Physician Services Specialist - Orthopaedics

This position will serve as an ambassador of care for patients before and after a patient visits, as well as before and after surgical procedures performed in clinic and the OR. The position will work as a resource to help support clinics and providers. The expectation from this position is that it will support and assist in departmental workflows, processes, and procedures to maintain departmental consistency and ensure patient satisfaction throughout the clinic and OR.

Qualifications

Minimum Required: High School Diploma or GED.

LICENSE & CERTIFICATION: N/A.

Minimum Required: 1 - 2 Years equivalent experience.

Must have vast knowledge of medical terminology for accuracy in chart review. attention to detail, ability to navigate the medical record, great organization, excellent customer service, and self-starting.

Administration:

• Answers telephone and direct to correct person if needed.

• Manages Outlook Calendar for providers within the clinic.

• Manages office incoming mail.

• Manages incoming communication related to case authorization.

• Validates registration information with patients and verifies all third-party payors (i.e. BWC, accident insurance, etc).

• Engages in population appropriate communication.

• Gives clear instructions to patients/family regarding treatment, diagnostic, procedural or surgical plan as directed by clinical team.

• Monitors and coordinates timely follow up for planned diagnostic procedure based upon the standard of care.

• Prepares for upcoming clinics related to procedural planning.

• Coordinate clinic template changes required to meet case and procedural obligations.

• Coordinates provider calendar related to faculty obligations.

• Performs in-basket management tasks.

• Coordinates completion of FMLA, Disability, BWC forms.

Scheduling:

• Schedules and coordinates patient services, surgeries, tests, and other procedures as needed.

• Coordinates all pre-procedural testing, diagnostic studies, medications, and other services as needed.

• Communicates with patients via phone and in person regarding scheduling related matters.

• Manages OR block time with providers Outlook calendar if applicable based on department guidelines.

• Reviews and coordinate case changes identified with leadership related to urgency, case order, or unforeseen delays.

• Helps review daily schedules as needed and make leadership aware if changes are needed or discrepancies are identified.

• Liaisons between staff and procedural areas for scheduling needs

• Coordinates with all product or device representatives for cases

• Completes complex coordination with co-surgeons in other surgical practices for joint case authorization and scheduling.

• Completes case request and referral order entry.

Data Management:

• Performs audits on patient records/registration for insurance billing and compliance.

• Reviews of office notes to ensure that all required items are noted for authorization request.

• Performs pre-authorizations and pre-certifications utilizing care management protocols.

• Utilizes payer portals to complete case, procedure, and visit authorizations.

• Coordinates peer to peer reviews for pending case authorization.

• Obtains CPT codes for all surgical and procedural cases and submit for authorization.

• Obtains retro authorizations as needed.

• Coordinates with utilization review for authorization status to avoid financial risk

• Updates documentation in referral tab with all authorization updates

Other duties as assigned