Procedure Scheduler

Job Summary:

The Surgical Procedure Scheduler coordinates surgical procedures with providers, hospitals, surgery centers, and patients. Responsibilities include scheduling procedures, obtaining insurance authorizations, coordinating preoperative requirements, reviewing patient financial responsibility, processing authorization requests, and collaborating with clinical and revenue cycle teams to ensure timely, accurate, and patient-centered care.

Essential Duties and Responsibilities:

Surgical Procedure Scheduling and Coordination

• Coordinate scheduling of surgical procedures with providers, hospitals, ambulatory surgery centers, and other procedural facilities.
• Review surgical orders, posting forms, and supporting documentation for completeness and accuracy.
• Enter and maintain scheduling information in the EHR, including procedure details, facility information, and relevant communications.
• Coordinate pre-admission testing (PAT), preoperative appointments, and other required scheduling activities.
• Communicate procedure details, scheduling updates, cancellations, reschedules, and changes in surgical plans to patients, providers, staff, and external facilities.
• Monitor scheduled procedures for outstanding requirements, including missing documentation, pending authorizations, and other barriers that may impact timely care.
• Ensure required scheduling workflows and pre-procedure requirements are completed and documented.
• Escalate urgent scheduling concerns, unresolved barriers, or potential delays in patient care to the appropriate clinical team or manager.

Insurance Authorization Management

• Determine payer authorization requirements for scheduled procedures, including prior authorizations and precertifications.
• Submit authorization requests and required clinical documentation within established timeframes.
• Follow up on pending authorization requests and maintain accurate authorization records in the EHR, including approval status, authorization numbers, approved services, and expiration dates.
• Communicate authorization approvals, denials, discrepancies, and outstanding requirements to appropriate stakeholders.
• Monitor authorization status and coordinate corrections to prevent avoidable delays, cancellations, denials, or reimbursement issues.
• Retroactive Authorization Processing
• Submit retroactive authorization requests within payer deadlines and provide all required supporting documentation.
• Follow up on outstanding requests and communicate status updates to appropriate departments.
• Escalate denied, delayed, or untimely requests and collaborate with appropriate teams to determine next steps.
• Identify recurring authorization issues and recommend process improvements to reduce future retroactive requests.

Patient Financial Responsibility and Communication

• Review insurance benefits and estimate patient financial responsibility for scheduled procedures, including deductibles, copayments, coinsurance, and other applicable obligations.
• Communicate estimated financial responsibility, payment expectations, and available financial assistance resources to patients before scheduled procedures whenever possible.
• Document patient financial discussions and refer patients to appropriate resources for additional assistance.
• Coordinate with billing staff to resolve outstanding financial questions and escalate discrepancies in benefit information or billing concerns as appropriate.
• Follow organizational policies regarding patient privacy, financial assistance, and collections. Do not guarantee coverage, determine final claim liability, or deny clinically necessary care based solely on estimated patient responsibility.

Documentation, Tracking, and Quality Assurance

• Maintain accurate and timely documentation in the EHR and approved tracking systems.
• Monitor work queues, reports, and tracking tools to identify outstanding scheduling, authorization, and financial requirements.
• Ensure all actions, changes, follow-up activities, and resolutions are documented appropriately.
• Protect patient information and comply with HIPAA, organizational policies, and applicable regulations.
• Participate in audits, workflow reviews, training, and continuous quality improvement initiatives.

Customer Service and Interdepartmental Collaboration

• Provide courteous, timely, and professional service to patients, providers, staff, insurance representatives, and external facilities.
• Serve as a liaison between providers, patients, payers, surgical facilities, billing staff, and other departments to facilitate efficient care coordination.
• Respond to inquiries and resolve routine scheduling, authorization, and patient financial concerns within the scope of the position.
• Participate in meetings, training, and process improvement activities as assigned.

General

• Maintain compliance with all HIPAA and privacy standards
• Maintain compliance with all company policies and procedures
• Other duties as assigned.

Monday - Friday 8:00 - 4:30