Arlington, TX US
Area of Interest:
Texas Health Resources System Services
Texas Health Resources is currently seeking a full time Clinical Review Scheduling Specialist II, to work in their Enterprise Scheduling Department located in Arlington, TX.
Full Time; 1st Shift
Monday-Friday; 9:00am – 5:30pm.
Could include Saturday hours during high volume season.
The ideal candidate will possess the following:
MINIMUM EDUCATION REQUIRED:
High School Diploma or Equivalent
Accredited Radiology Program graduate preferred
MINIMUM EXPERIENCE REQUIRED:
7 years with direct, in-hospital radiology experience
Epic Cadence experience preferred
Experience with Breast Center Imaging, or Ultrasound highly preferred
Epic Cadence experience preferred
Basic Medical Terminology
Basic Computer Knowledge
Familiarity with office equipment (fax, copier, multi-line phone etc.)
Certified Radiology Technologist OR Certified Coder upon hire.
The Clinical Reviewer II will be responsible for reviewing incoming orders for completeness and accuracy. Upon review, the Clinical Reviewer II will transcribe orders into the scheduling system. Clinical Reviewers will communicate with physicians’ offices to resolve incomplete orders in a timely manner to benefit the patient experience. Clinical Reviewer II will have hands-on clinical radiology experience. This position requires knowledge of radiology procedures and the diagnostic codes required for those procedures. This position will also be involved with reviewing clinical denials to identify trends and develop processes to avoid denials. Clinical Reviewer II will serve as a subject matter expert for radiology procedures and help provide training to schedulers of these procedures. Candidates should have excellent communications skills, both verbal and written.
JOB DUTIES: (Including but not limited to)
* Review Orders for appropriateness and completeness and validity. Refers to the THR ES Scheduling Permissions to determine scheduling status. Assess appropriateness of diagnosis. ICD 10 assessment. Assess medical appropriateness of services ordered. Transcribe orders for specific entity -deemed as operational task.
-Process incoming orders via Trace in a timely manner. Review orders to ensure criteria are met for valid order status. Document order management in Rad Notes accordingly.
-Determine if order has been used for prior visit/validate if less than 1 year old/
-Compare data from different sources (Careconnect/Trace/Protocol) to determine the course of action for managing orders.
-Review patient exam history/date for indications-consideration of patient age/history/family history/results from last exam, or most recent symptoms.
-Review order to identify any exceptions for using order more than one time (eg. orders for repeat studies or SDOstanding delegate order), or need for contingency exam is necessary.
-Perform Medessary checks for medical necessity for all patients with Medicare as a payor. Perform necessary documentation steps with PixCert and Careconnect.
-Documentation on Appointment if scheduled/Update Tracker Field.
* Ensure accurate and necessary data sets are present all orders. Each order should be verified to meet the Outpatient services policy for orders:
-Patient's Demographics/Date order was written/Provider's signature with credentials/Specific test/service ordered/Diagnosis/symptom to support reason for diagnostic test/study.
-Must include diagnosis/description (narrative) and Valid ICD code for medical necessity validation.
-Recurring orders must include frequency and duration.
* Act as the subject matter expert / liaison. Communicate effectively with physician offices on incomplete orders. Build relationships with physician offices to further then advancement of the department objectives. Communicate effectively with clinical department for complex cases and review of protocols. Respond to mail, fax, or telephone inquiries and seek assistance as appropriate. Establish and maintain working relationships with staff, doctor's offices, and other internal and external departments to deliver services.
-Contact the provider's office to inform them an order has not been received and is required, or does not meet the required standards for outpatient orders.
-Clearly articulate the reason for order status to the provider in a manner that supports the appropriate diagnosis or procedural need.
Document within Cadence the number of attempts made to secure the order or the final disposition of the order within the Radiology Notes.
-Utilize TRACE fax system for communication of order issues or requests for ICD 10 narratives.
* Parse and Index incoming orders to appropriate destination. Orders coming into to Enterprise Scheduling via TRACE must be indexed.
-Ensure accuracy of indexing correct fields: Name/DOB/Physician name/Service department.
-Determine In-Scope Radiology orders vs Out-of-Scope orders/ Refer to ES Permissions' list
-Magic Fax orders
-Documenting Initial Review Status/Documenting Current Review Status/Marking Complete/Updating Date of Service
-Fax out orders for missing elements or special handling requests to the appropriate location(s)
-Splitting multiple orders for multiple patients with accuracy
-Validate and classify STAT/Emergent orders in a desired time frame for immediate action.
-Identify & Escalate Order issues for resolve in a timely manner with Manager/Director resource
*Responsible for reporting to work on time and as scheduled per THR's Time and Attendance Policy. Adhere to System, hospital, and departmental policies and procedures. Responsible for attending and participating in dept. meetings throughout the year. Participate in any additional meetings as requested by Manager/Director Completing MyTalent educational requirements and THR requirements by the established deadline. Maintain confidentiality at all times. Parse and Index incoming orders to appropriate destination.
-Maintain ownership of their clock records/clocking in/out daily. Adhering to work-shift schedule times and punctuality.
-Completion of designated mandatory assignments in a timely manner. No compliance issues.
-Completion of employee health requirements by established deadline.
-Demonstrate compliance and be accountable for Business Ethics on a day-to-day basis.
Texas Health Resources is one of the largest faith-based, nonprofit health care delivery systems in the United States and the largest in North Texas in terms of patients served.
Texas Health has 25 acute-care and short-stay hospitals that are owned, operated, joint-ventured or affiliated with the system. It has more than 3,800 licensed beds, more than 21,100 employees of fully-owned/operated facilities plus 1,400 employees of consolidated joint ventures, and counts more than 5,500 physicians with active staff privileges at its hospitals.
At Texas Health, we strive to create an atmosphere of respect, integrity, compassion and excellence for all who come in contact with us, be they patients or our employees. We are committed to diversity in our workforce, and our mission to serve spreads across ethnic, cultural, economic and generational boundaries. We invite you to join us in furthering your career through our accomplishments and philosophy of excellence.