Physician Services Specialist, Wound Care, Full Time, First Shift in Chester

This position will serve as an ambassador of care for patients before and after a visit, as well as before and after surgical procedures performed in the clinic and the OR. The position will work as a resource to help support clinics and providers and support departmental workflows, processes, and procedures to maintain consistency and ensure patient satisfaction throughout the clinic and OR.

Location: West Chester, OH, United States

Qualifications

• Minimum Required: High School Diploma or GED.
• Minimum Required: 1 - 2 years of equivalent experience.
• Must have vast knowledge of medical terminology, attention to detail, ability to navigate the medical record, great organization, excellent customer service, and self‑starting.

Responsibilities

• Answers telephone and directs to correct person if needed.
• Manages Outlook calendar for providers within the clinic.
• Manages office incoming mail.
• Manages incoming communication related to case authorization.
• Validates registration information with patients and verifies all third‑party payors.
• Engages in population‑appropriate communication.
• Gives clear instructions to patients/family regarding treatment, diagnostic, procedural or surgical plan as directed by the clinical team.
• Monitors and coordinates timely follow‑up for planned diagnostic procedures based upon the standard of care.
• Prepares for upcoming clinics related to procedural planning.
• Coordinates clinic template changes required to meet case and procedural obligations.
• Coordinates provider calendar related to faculty obligations.
• Performs in‑basket management tasks.
• Coordinates completion of FMLA, disability and BWC forms.

Scheduling

• Schedules and coordinates patient services, surgeries, tests, and other procedures as needed.
• Coordinates all pre‑procedural testing, diagnostic studies, medications, and other services as needed.
• Communicates with patients via phone and in person regarding scheduling related matters.
• Manages OR block time with providers’ Outlook calendar if applicable based on department guidelines.
• Reviews and coordinates case changes identified with leadership related to urgency, case order, or unforeseen delays.
• Helps review daily schedules as needed and make leadership aware if changes are needed or discrepancies are identified.
• Liaisons between staff and procedural areas for scheduling needs.
• Coordinates with all product or device representatives for cases.
• Completes complex coordination with co‑surgeons in other surgical practices for joint case authorization and scheduling.
• Completes case request and referral order entry.

Data Management

• Performs audits on patient records/registration for insurance billing and compliance.
• Reviews office notes to ensure all required items are noted for authorization requests.
• Performs pre‑authorizations and pre‑certifications utilizing care management protocols.
• Utilizes payer portals to complete case, procedure, and visit authorizations.
• Coordinates peer‑to‑peer reviews for pending case authorization.
• Obtains CPT codes for all surgical and procedural cases and submits for authorization.
• Obtains retro‑authorizations as needed.
• Coordinates with utilization review for authorization status to avoid financial risk.
• Updates documentation in referral tab with all authorization updates.