Delaware Valley University

Scheduling Coordinator

• Obtain prior authorization and precertification for pain management procedures, diagnostic testing, medications when assigned, and other services requiring payer approval.
• Verify insurance benefits, eligibility, authorization requirements, and applicable payer guidelines prior to scheduling procedures.
• Submit clinical documentation and authorization requests to insurance carriers and third party utilization management organizations.
• Track pending authorization requests and follow up with insurance carriers until a determination is received.
• Communicate authorization requirements, denials, requests for additional information, and peer to peer requirements to the physician and clinical staff.
• Coordinate additional clinical documentation and assist with authorization-related denials and appeals.
• Maintain accurate authorization records, payer communications, and patient medical-record documentation.
• Monitor authorization expiration dates and ensure procedures are scheduled within approved timeframes.
• Schedule pain management procedures, follow-up appointments, and other physician services.
• Coordinate procedure dates with patients, physicians, facilities, and clinical staff.
• Provide patients with scheduling information, procedural instructions, and approved appointment information.
• Confirm authorization and documentation are complete before scheduled procedures.
• Manage cancellations, rescheduling, and changes to the physician's procedural schedule.
• Serve as the primary administrative support for the assigned pain management physician.
• Manage the physician's administrative schedule and practice-related calendar.
• Assist with correspondence, forms, documents, phone calls, meetings, appointments, and other administrative requests.
• Coordinate communication among the physician, patients, clinical staff, facilities, referring offices, and departments.
• Maintain organized records and follow-up systems for outstanding administrative items.
• Monitor work queues and outstanding tasks for timely completion.
• Participate in training and maintain knowledge of payer requirements and practice workflows.
• Maintain professional communication and perform additional assigned duties.

Pain Management Authorization – Scheduling Coordinator

Medical Billing and Coding

• Manage billing and accounts receivable for Pennsylvania Workers’ Compensation claims
• Perform consistent follow-up on outstanding, unpaid, and underpaid Workers’ Compensation claims
• Communicate with insurance carriers, third-party administrators, adjusters, nurse case managers, and other claim representatives to resolve outstanding balances
• Review payments and remittance documentation for accuracy and identify inappropriate reductions, denials, and underpayments
• Research and resolve denied or rejected bills involving claim information, authorization, compensability, documentation, coding, and billing requirements
• Prepare and submit reconsiderations, appeals, corrected bills, and supporting documentation
• Identify discrepancies between billed charges, expected reimbursement, and actual payments
• Maintain accurate account notes documenting collection activity and follow-up
• Work Workers’ Compensation aging reports systematically and prioritize accounts requiring immediate action
• Obtain and verify claim information, including carrier/TPA, adjuster information, claim numbers, dates of injury, and authorization information
• Identify recurring denial and payment trends and escalate systemic issues to management
• Collaborate with coding, authorization, clinical, and front-end teams to resolve reimbursement issues
• Maintain consistent account follow-up and meet established productivity and A/R performance expectations

Pain Management Authorization – Scheduling Coordinator

Workers’ Compensation Medical Billing Specialist