Summary:
The Surgical Resource Specialist is responsible for coordinating the surgical encounter for patients and physician offices with mastery of site rules and resources for Santa Fe surgical areas, along with multi-disciplinary and complex specialties. Demonstrates leadership and proficiency in scheduling, and all other prescribed work flow. Requires strong communication skill set and is a role model for achieving exceptional patient experience for our patients and members. Responsible for adjusting and consolidating surgical schedules across Santa Fe surgical facilities on a daily basis to maximize efficiency. Manages all insurance initiatives and protocols. Serves as liaison to multiple departments, leadership, and anesthesia.
Type of Opportunity: Full Time
FTE: 1.000000
Exempt: No
Work Schedule: Days
Other information:
Education: High school or equivalent required
* A minimum of four years of experience as a medical scheduler or medical assistant with experience in complex surgical procedures
* Solid computer skills with ability to type minimum 45 WPM
* Proficiency in prior authorization, certification, referral process
* Working knowledge of CPT and ICD-10 coding
* Pass annual competency exams for all areas of responsibility
* Training in Medical Terminology is required
* Requires strong organizational skills
* Must be able to function under pressure while maintaining professionalism
Education:
Essential:
* High School Diploma or GED
Responsibilities:
Encounter Components:
*Serves as role model and assists in the surgical scheduling process in the Epic Op-Time application with accuracy and efficiency. Validates accurate patient demographics, and enters all resources related to the case. Manages canceling and rescheduling processes at provider s request
* Perform final confirmation of all surgical cases scheduled via verbal confirmations or case data sheets
* Serves as a subject matter expert for Santa Fe surgical areas, including site rules and resource availability
* Manages daily insurance process along with the liaison from Insurance Verification. Communicates and removes patients with unsecured accounts
* Serves as a liaison for PASS, and Santa Fe surgical areas
* Audits the Medical Necessity, Consent for Sterilization, and Hysterectomy protocols. Collects and audits all forms for accuracy as needed for surgical procedures
*Demonstrates expertise in all scheduling protocols, including block utilization and management, with the ability to direct PMG patient schedulers and independent physician office staff on the protocols
*Serves as subject matter expert regarding scheduling accuracy, procedure abbreviations, site rules, and resource availability for all CDS surgical facilities and other protocols as needed
*In collaboration with the manager of Surgical Services, generate statistics, analyze and interpret data
Financial Accountabilities:
* Must possess in-depth knowledge of all insurance initiatives and protocols, serving as liaison for Insurance verification, Financial Advocacy, and the Pre-Registration Departments
* Manages the Medicare, Tricare, and PHP Senior In-Patient only process
Phone Queue Management:
* Manage and monitor the phone queue using the CC Pulse application. Adjust workflow as needed.
Medical Record Components:
* Recognize and identify all discrepancies found in patient s medical records, commits to clear and concise communication with Health Information Management in order to ensure accuracy
* Navigate the CACTUS and I-Privileges applications to validate clinical credentials, along with acting as liaison to the Medical Staff Affairs Department
Customer Service and Caring Practices:
* Achieve exceptional patient and member experience for customers by using CARES, AIDET, and Exceptional Patient Experience tools
* Addresses and appropriately resolve complaints in the moment by using key words at key times
* Ability to manage conflict and appropriately request the help of a supervisor when needed
* Develop and maintain positive, collaborative relationships with PMG patient schedulers, and independent physicians and office staff
* Comprehend quality service connection to patient and provider satisfaction and revenue
* Participate in metric goals for telephone queue performance
*Participate in quality improvement processes
* Is a mentor, trainer, and resource for new employees as well as other stake holders
* Collaborate with outside departments, and companies to coordinate higher levels of patient care
* Communicate effectively to all patients, peers, and site leadership
*Serve as liaison to Surgical Revenue Department
*Perform the daily verbal final confirmation of Santa Fe Surgical sites with physician offices, O.R. Charge Nurses, Anesthesia Liaison, and other stakeholders
Environment of Care:
* Maintain personal workspace to assure area is clean and clear of any unnecessary items.
* Participate in rotation of office housekeeping duties to maintain a healthy work environment
* Other duties as assigned
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About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system comprised of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 13,000 employees - including more than 1,200 providers and nearly 3,500 nurses.
Our health plan serves more than 640,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.