ABOUT US:

With energy and purpose, Cooley Dickinson Health Care, a member of the Mass General Brigham system, is advancing health care in western Massachusetts, and has been since 1886. Our network employs more than 2,000 medical professionals and support staff, at our main Hospital campus in Northampton and additional locations in twelve towns throughout the Pioneer Valley.

OUR BENEFITS:

In addition to competitive pay, all Cooley Dickinson employees who work 20 hours or more per week have access to the following benefits with no waiting period:

• A range of health, dental, vision, prescription, and life insurance benefits.
• A generous and flexible Earned Time Off program starting at six weeks accrual per year.
• 403(b) retirement plan with various investment options.
• Opportunities and support for continued education including tuition reimbursement.

SHIFT: Monday - Friday 7:00am-3:30pm, hybrid after 90 days of successful onsite training (3 days onsite/2 days remote)

MAIN FUNCTION:

The Pre-Service Coordinator is responsible for performing patient pre-service functions which includes procurement of all pre-certifications, referrals, and medical necessity verification for Radiology exams. The Pre-Service Coordinator is responsible for researching updated insurance medical policies related to Radiology exams, which includes research and appeals of any Radiology denials.

This position reports to the Centralized Scheduling Manager and operates within established organizational and departmental policies and procedures.

ESSENTIAL JOB FUNCTIONS:

• Perform medical necessity checks as outlined by departmental policy and procedures and advise physician's office if additional diagnostic information is required. Advise patient of ABN requirements if medical necessity does not pass.
• Follow insurance guidelines and keep up to date with all insurance requirements and stipulations in order to obtain reimbursement.
• Works productively with all members of the Centralized Scheduling/Registration Team. Accepts and contributes to all goals and objectives established by management.
• Validate and secure all necessary prior authorizations utilizing payer websites and or contacting referring physician's office for additional information. Notify the Scheduling department if an authorization is not obtained within the established guidelines, for appointment rescheduling.
• Utilize multiple computer systems in order to obtain necessary authorizations, medical necessity and scheduling options.
• Interact effectively with patients and doctor's offices in order to gather correct, complete data necessary to ensure that clinical and fiscal responsibilities are facilitated, for both the patient and the Hospital. Follow manual procedures when computer system is not functioning properly.
• Maintain insurance payer authorization and medical necessity requirement grid; distribute to scheduling staff as updated.
• Research any denials received for Radiology exams. File appeals as necessary. Maintain denial spreadsheet.
• Stay current with new regulations of the many public and private insurance companies which patients carry; such as Medicare, Blue Cross HMO's, Health New England, Tufts, Worker's Comp, and Liability - pre-authorization approval guidelines and medical necessity requirements.
• Provide patient information in accordance with regulations governing divulgence of information (HIPPA).
• Maintain confidentiality of all patients' records and data. Interface with medical records and billing department as required based on department, hospital and patient care needs.
• Meet annual competency and retraining requirements.
• Maintain established hospital and departmental policies and procedures, objectives, confidentiality, patient satisfaction, employee satisfaction, quality improvement program, safety, compliance and environmental standards.
• Maintain professional growth and development through attendance at seminars, workshops, conferences or in-services to stay abreast of current trends.
• Provide coverage for extra shifts in case of unexpected absence of staff members or for vacation coverage for patient care needs. Work a flexible schedule as needed for business purposes.
• Perform other functions/duties as requested.

MINIMUM REQUIREMENTS:

• High school diploma or equivalent required
• Two (2) to three (3) years administrative and in-person customer service experience required, preferably in a health care setting
• Familiarity with and understanding of all major health insurers and general coverage issues required
• Previous experience with and the understanding of insurance authorizations required
• Demonstrated knowledge of medical terminology required
• Spelling and typing competence with computer experience required; Excel spreadsheet experience preferred
• Excellent oral and written communication skills, including the ability to communicate effectively with the public, physicians, and all hospital personnel in a high volume setting and the ability to multi task required