Surgical Resource Specialist-SF - SURGERY

Summary:
The Surgical Resource Specialist is responsible for coordinating the surgical encounter for patients and physician offices with mastery of site rules and resources for Santa Fe surgical areas, along with multi-disciplinary and complex specialties. Demonstrates leadership and proficiency in scheduling, and all other prescribed work flow. Requires strong communication skill set and is a role model for achieving exceptional patient experience for our patients and members. Responsible for adjusting and consolidating surgical schedules across Santa Fe surgical facilities on a daily basis to maximize efficiency. Manages all insurance initiatives and protocols. Serves as liaison to multiple departments, leadership, and anesthesia.

Type of Opportunity: Full Time
FTE: 1.000000
Exempt: No
Work Schedule: Days

Other information:
Education: High school or equivalent required
* A minimum of four years of experience as a medical scheduler or medical assistant with experience in complex surgical procedures
* Solid computer skills with ability to type minimum 45 WPM
* Proficiency in prior authorization, certification, referral process
* Working knowledge of CPT and ICD-10 coding
* Pass annual competency exams for all areas of responsibility
* Training in Medical Terminology is required
* Requires strong organizational skills
* Must be able to function under pressure while maintaining professionalism

Education:
Essential:
* High School Diploma or GED

Responsibilities:
Encounter Components:
*Serves as role model and assists in the surgical scheduling process in the Epic Op-Time application with accuracy and efficiency. Validates accurate patient demographics, and enters all resources related to the case. Manages canceling and rescheduling processes at provider s request
* Perform final confirmation of all surgical cases scheduled via verbal confirmations or case data sheets
* Serves as a subject matter expert for Santa Fe surgical areas, including site rules and resource availability
* Manages daily insurance process along with the liaison from Insurance Verification. Communicates and removes patients with unsecured accounts
* Serves as a liaison for PASS, and Santa Fe surgical areas
* Audits the Medical Necessity, Consent for Sterilization, and Hysterectomy protocols. Collects and audits all forms for accuracy as needed for surgical procedures
*Demonstrates expertise in all scheduling protocols, including block utilization and management, with the ability to direct PMG patient schedulers and independent physician office staff on the protocols
*Serves as subject matter expert regarding scheduling accuracy, procedure abbreviations, site rules, and resource availability for all CDS surgical facilities and other protocols as needed
*In collaboration with the manager of Surgical Services, generate statistics, analyze and interpret data
Financial Accountabilities:
* Must possess in-depth knowledge of all insurance initiatives and protocols, serving as liaison for Insurance verification, Financial Advocacy, and the Pre-Registration Departments
* Manages the Medicare, Tricare, and PHP Senior In-Patient only process
Phone Queue Management:
* Manage and monitor the phone queue using the CC Pulse application. Adjust workflow as needed.
Medical Record Components:
* Recognize and identify all discrepancies found in patient s medical records, commits to clear and concise communication with Health Information Management in order to ensure accuracy
* Navigate the CACTUS and I-Privileges applications to validate clinical credentials, along with acting as liaison to the Medical Staff Affairs Department
Customer Service and Caring Practices:
* Achieve exceptional patient and member experience for customers by using CARES, AIDET, and Exceptional Patient Experience tools
* Addresses and appropriately resolve complaints in the moment by using key words at key times
* Ability to manage conflict and appropriately request the help of a supervisor when needed
* Develop and maintain positive, collaborative relationships with PMG patient schedulers, and independent physicians and office staff

* Comprehend quality service connection to patient and provider satisfaction and revenue
* Participate in metric goals for telephone queue performance
*Participate in quality improvement processes

* Is a mentor, trainer, and resource for new employees as well as other stake holders

* Collaborate with outside departments, and companies to coordinate higher levels of patient care

* Communicate effectively to all patients, peers, and site leadership

*Serve as liaison to Surgical Revenue Department

*Perform the daily verbal final confirmation of Santa Fe Surgical sites with physician offices, O.R. Charge Nurses, Anesthesia Liaison, and other stakeholders

Environment of Care:
* Maintain personal workspace to assure area is clean and clear of any unnecessary items.
* Participate in rotation of office housekeeping duties to maintain a healthy work environment
* Other duties as assigned

We offer more than the standard benefits!

Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!

Learn more about our employee benefits:

Why work at Presbyterian?

As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.

Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.

About Presbyterian Healthcare Services

Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

About Our Regional Delivery System

Presbyterian's Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state's largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities.

We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

About New Mexico

New Mexico continues to grow steadily in population and features a low cost-of living.

Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.

New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.