Pre-Svc Order Mgmt Spec

Major Responsibilities:

• Reviews physician outpatient orders to ensure orders are compliant and contain all required elements within hospital and regulatory guidelines, including a valid diagnosis for each procedure ordered, so that services can be performed. Contacts physician offices when clarification or when additional information is needed.
• Screens external (non-Epic) providers who send outpatient orders to ensure that provider meets qualifiers for writing orders:  Checks for licensure and NPI number. Checks appropriate state and federal websites to ensure that no sanctions exist.
• Reviews faxed physician orders for compliance with federal guidelines and medical necessity as per Medicare’s National and Local Medical Review Policies as needed to determine if an advance beneficiary notice should be issued.  Understands the current guidelines related to Medicare medical necessity and National and Local Medical Review Policies.  Notifies physician when a faxed order fails to meet Medicare medical necessity guidelines and facilitates.  Communicates to registration staff when an outpatient test does not meet Medicare medical necessity requirements.
• Performs the duties required to ensure outside faxed orders are indexed and transcribed so that services can be scheduled with ease.  Indexes faxed physician orders in electronic order tracking system so that the order can be easily found by any scheduler, OMS team member, site registration team members, or other leaders.  Transcribes and links valid orders so the transcription is available for ease of scheduling.
• Performance of other duties:  Attends and participates in hospital and department meetings as required.  Trains new team members regarding policies and procedures relative to this position as needed.  Performs other duties as assigned by supervisor/manager.

Education/Experience Required:

• Education: High school diploma or equivalent (GED)
• Experience: Typically requires a minimum of 3 years related work experience

Knowledge, Skills & Abilities Required:

• Demonstrates a basic knowledge of ICD-10-CM diagnosis and CPT procedure coding.
• Thorough understanding of medical terminology, anatomy and physiology.
• Must have strong written and verbal English communication skills, understand and provide verbal instructions, ask questions, and give directions to and from providers, staff, patients, and family members.  Uses non-verbal understanding cues as appropriate.
• Sufficient auditory and visual acuity, including color vision and depth perception.
• Ability to read handwritten orders and to utilize written and computerized resource material.
• Strong interpersonal, organizational, decision-making and problem-solving skills for working with staff, patients, physicians and computer applications.
• Ability to meet and maintain documented productivity and quality standards.
• Ability to build excellent reciprocal customer relationships with providers, patients, staff, family and all ancillary departments served.
• Ability to remain calm and courteous while working under stressful situations.
• Ability to properly utilize age-related developmental characteristics in the provision of care for patients/customers of all age groups, as stated above.

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Physical Requirements and Working Conditions:

• Availability and flexibility in life schedule to accommodate department hours 7:00 AM to 7:00 PM, Monday through Friday with rotating Saturdays, 7:30 AM to 4:00 PM.
• Ability to sit for an extended period of time.
• Must have normal or corrected vision in order to read computer screens.
• Use a keyboard and video display terminal to enter, receive, retrieve, transform words or data and/or audit information and data continuously.
• Able to stand, stoop, squat, kneel, grab with arms, and utilize manual dexterity continuously.
• Ability to lift up to 35 pounds without assistance.

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This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.