Ophthalmic Surgery Navigator

Who We Are:

As the only independent and physician-led faculty practice plan of the University of Tennessee Health Science Center, University Clinical Health (UCH) offers best-in-class clinical care through a network of 175+ providers across 19 specialties to meet the healthcare needs of the Mid-South community. UCH is a not-for-profit, non-tax-supported group practice and is here to serve the community while providing medical excellence to our patients. University Clinical Health is an Equal Employment Opportunity Employer, including disability and protected veteran status. University Clinical Health is a VEVRAA Federal Contractor.

Position Summary:

The Ophthalmic Surgery Navigator (OSN) will communicate clearly and frequently with the team to ensure Ophthalmology patients receive the highest level of care. The OSN will utilize their clinical knowledge to schedule appropriate procedures/surgeries per the provider's orders. A successful Ophthalmic Surgery Navigator will exhibit excellent customer service skills with patients, employees, and the public. In addition, will be responsible for responding to written and oral correspondence regarding scheduling changes/cancellations in a timely, accurate manner.

Key Results Areas (KRAs):

* Schedule office and hospital-based medical procedures for patients with appropriate provider and time/location slot, utilizing appropriate scheduling templates.

* Interact with appropriate hospital staff to ensure a cohesive working relationship in providing patient care services.

* Enter notes/special instructions needed for scheduling in the electronic medical record.

* Complete accurate documentation of informed consent with patients for procedures and surgeries as needed.

* Provide accurate, detailed information to patients regarding test preparations, time of patients' scheduled arrival, and any other directional information needed; takes appropriate action to respond to patients' questions.

* Schedule pre-operative/postoperative appointments for all Ophthalmic surgeries.

* Obtains precertification/preauthorization from insurance companies before surgery for each procedure and test, using an online application or by contacting insurer via telephone

* Prioritize incoming authorization requests according to urgency and schedule procedures as required. Confirms patient's insurance provider and obtains prior authorization with the appropriate parties as needed.

* Confirm the accuracy of CPT and ICD-10 diagnoses in the procedure order.

* Maintain individual payer files to include up-to-date requirements needed to obtain authorizations successfully.

* Initiate appeals for denied authorizations.

* Ensure patients have proper medical clearance and pre-surgical testing as needed. Completes pre-procedure phone calls and confirms appointment times with patients via telephone.

* Verify patient eligibility and coverage for the procedure using an online application or the telephone; communicate to patients of their ineligibility on date of service or if procedure is not a covered benefit.

* Counsel patients pre-operatively regarding their potential financial obligations and provide information about patient insurance coverage.

* Deliver pre-operative handout instructions to the patient, as directed by physicians

* Assist patients with setting up payment plans and collects all co-pays, co-insurances, pre-surgical deposits, and total amounts.

* Schedule operating room time according to physician scheduling protocols; faxes H&P to hospital admitting department.

* Schedule all appropriate pre-operative tests and blood work.

* Coordinate all business and clinical paperwork before surgery, using physician-approved forms and checklists; has paperwork ready for surgeon before the day of surgery.

* Maintain communication among the physician, patient, insurance company, and hospital at all times.

* Maintain patient confidentiality; complies with HIPAA and compliance guidelines established by the practice.

* Attend all regular staff meetings.

* Completes all other duties as assigned by Ophthalmology Leadership.

* Travel to satellite Ophthalmology clinics within UCH Ophthalmology as needed

Core Competencies

* Knowledge of procedure authorization and its direct impact on the practice's revenue cycle

* Knowledge and flexibility to schedule for all Ophthalmology clinics

* Understanding of payer medical policy guidelines while utilizing guidelines to effectively manage authorizations

* Basic understanding of Ophthalmic anatomy

* Proficient use of CPT and ICD-10 codes

* Ability to multitask and remain focused while managing a high-volume, time-sensitive workload

* Consistent professional conduct and meticulous attention to detail

* Excellent verbal and written communication skills as well as interpersonal skills with patients, staff, and other healthcare professionals

* Critical thinking skills and a positive attitude essential

* Committed to supporting UCH's standard to medical excellence

Education & Experience:

• High School diploma or equivalent required. College education Preferred
• At least 2 years of experience in a medical-related customer service position Required
• Proficient computer skills, including Excel, Word, and Internet use, Required
• 2 years of medical prior authorization experience, Preferred
• Formal education or training in Ophthalmology Preferred