Lehigh Valley Health Network

Scheduling Coordinator

• Coordinate patient scheduling activities for appointments, procedures, and exams across hospitals, physician practices, outpatient departments, modalities, and facilities
• Facilitate communication between staff, referral sources, and physician offices regarding scheduling concerns and issues
• Collect clinical information, obtain insurance, and verify patient demographics for screening and diagnostic test scheduling
• Schedule patients for physician appointments and diagnostic test procedures
• Educate patients, families, and physician offices about department protocols, procedures, insurance, referrals, and testing criteria
• Monitor practice protocols and department procedures and recommend improvements
• Use scheduling software and patient-specific software applications to facilitate patient access
• Serve as a resource for staff, physicians, and referring offices
• Reduce errors, rework, and defects through conscientious attention to detail

• Coordinate all patient scheduling activities including appointments, procedures, and exams for multiple hospital, physician practice, outpatient departments, modalities, and facilities
• Facilitate communication between staff, referral sources and physician offices regarding scheduling concerns/issues
• Collect clinical information, obtain insurance, and verify patient demographics for appropriate scheduling of screening and diagnostic tests
• Schedule patients for physician appointments and diagnostic test procedures
• Educate patients, families and physician offices regarding department protocols, procedures, insurance, referrals and testing criteria
• Monitor practice protocols and department procedures and make recommendations for improvement
• Utilize scheduling software and other patient-specific software applications to facilitate patient access into the network
• Serve as a resource for staff, physicians, and referring offices
• Reduce errors, rework and defects through conscientious attention to detail

• Coordinate all patient scheduling activities, including appointments, procedures, and exams
• Facilitate communication between staff, referral sources, and physician offices regarding scheduling concerns and issues
• Collect clinical information, obtain insurance, and verify patient demographics
• Schedule patients for physician appointments and diagnostic test procedures
• Educate patients, families, and physician offices regarding protocols, procedures, insurance, referrals, and testing criteria
• Monitor practice protocols and department procedures and recommend improvements
• Utilize scheduling software and patient-specific software applications to facilitate patient access
• Serve as a resource for staff, physicians, and referring offices
• Reduce errors, rework, and defects through conscientious attention to detail

Nurse

• Provide professional nursing care to designated patients in an outpatient facility, clinic, or virtual setting
• Coordinate care across the continuum
• Assess, plan, implement, and evaluate patient care to ensure optimal patient satisfaction
• Deliver skilled practical nursing care, including medication administration and procedures
• Provide patient and family education and evaluate its effectiveness
• Maintain current and appropriate education materials
• Intervene to prevent, minimize, or correct actual or potential patient risks
• Act as a resource for patients and family members
• Listen effectively and give and receive constructive feedback
• Maintain accurate and up-to-date patient records in compliance with legal and ethical standards
• Participate in clinical meetings and multidisciplinary quality service improvement initiatives
• Maintain a safe work environment and clinical and professional competency

Registered Nurse

Clinical Data Coordinator

• Analyze requested claims data to identify pre- and post-pay audit trends and claim denial trends by facility location, payers, and service lines
• Prepare reports reflecting RAC audits, insurance, third-party activities, and claim denials
• Log audit and claim denial requests, review findings and determinations, and evaluate logging and tracking processes
• Identify workflow roadblocks and make recommendations to management and the software vendor
• Develop and maintain relationships with clients, staff, management, and insurance/vendor representatives
• Communicate audit activity results through written reports and oral presentations to management
• Complete audit follow-up and closure
• Create educational materials for audit tracking software and provide ongoing staff training
• Review and file mail received via fax, scanning, and email, assigning it to appropriate work queues
• Coordinate appeals sent via RightFax and maintain a database of appeals
• Assist clinical audit and follow-up teams with write-offs and management work queues
• Attend monthly insurance/payer vendor meetings to stay current on policy and billing updates

Audit Clinical Data Coordinator

• Analyze requested claims data to identify pre- and post-pay audit trends and claim denial trends by facility location, payers, and service lines
• Prepare reports reflecting RAC audits, insurance and third-party activities, and claim denials
• Log audit and claim denial requests, review findings and determinations in the audit tracking database, and evaluate logging and tracking processes
• Log all claim denials
• Identify workflow roadblocks and make recommendations to management and the software vendor
• Develop and maintain relationships with clients, staff, management, and insurance/vendor representatives
• Communicate audit activity results through written reports and oral presentations to management
• Complete audit follow-up and closure
• Create educational materials for audit tracking software and provide ongoing staff training
• Review and file incoming mail via fax, scanning, and email, assigning it to appropriate work queues
• Coordinate appeals sent via RightFax and maintain an appeals database
• Assist clinical audit and follow-up teams with write-offs and management work queues
• Attend monthly insurance/payer vendor meetings and stay current on policy and billing updates

Registrar

• Manage and maintain database abstraction of clinical data from multiple sources
• Abstract and submit all required data elements into the Collector system as required by PTSF
• Communicate information to the Trauma Team regarding trauma audit filters or identified care issues
• Identify all trauma patients admitted to LVH and encountered by the trauma service
• Flag trauma patients in the EPIC system
• Compile data following NTDS and NTRACS data requirement guidelines
• Complete abstracts of all data from admission to discharge on assigned charts
• Collect patient records before and after discharge for review, analysis, and diagnosis entry into the trauma registry database

Trauma Registrar

Attorney

• Conduct outreach to patients, family members, care facilities, and designated representatives to obtain documentation required for Medicaid applications
• Guide and educate patients and families on Medicaid eligibility requirements, application processes, documentation needs, and deadlines
• Collect, review, verify, and organize financial, legal, and personal documentation to support Medicaid eligibility determinations
• Prepare, submit, and track Medicaid applications, ensuring accuracy, completeness, and timely filing
• Maintain detailed records of patient interactions, application status, documentation requests, and case outcomes
• Collaborate with patients, attorneys, social workers, case managers, financial counselors, and government agencies to resolve application issues and secure approvals
• Monitor pending applications, proactively address deficiencies or delays, and follow up on outstanding requirements
• Partner with organizational leadership to identify patients requiring Medicaid assistance and support reimbursement optimization through successful enrollment outcomes
• Ensure compliance with Medicaid regulations, HIPAA requirements, and organizational policies while maintaining confidentiality and reporting on application outcomes and productivity metrics

Legal Eligibility Coordinator

Authorization Specialist

• Obtain benefits and authorizations for surgical procedures, diagnostic testing, medications, outgoing referrals, and other services
• Determine authorization protocols for each health plan
• Perform billing duties to ensure proper and timely payment from insurance carriers and patients
• Collaborate with physicians and provider office staff to ascertain appropriate authorization based on medical necessity and treatment plans
• Perform medical necessity checks to determine whether procedure and diagnosis support medical necessity
• Ensure authorizations comply with network policy and communicate exceptions to the ordering office, patient, and manager
• Communicate with insurance companies to obtain insurance verification, benefits, and precertification approvals
• Verify additional clinical information and insurance authorizations/referrals
• Review and monitor WQs/schedules to ensure proper and accurate authorization before patient visits
• Maintain compliance with benchmark data regarding accounts registered versus scheduled procedures
• Determine estimated patient financial responsibility using insurance verification information, payer contracts, and/or self-pay guidelines