Under the direction of the Director, Patient Access, reviews and prints clinic schedules from CCC. Verifies insurance eligibility and benefits and referral and authorization requirements for the Clinics. Ensures all exams requiring a Prior Authorization and/or Referral are coordinated through the appropriate insurance provider or intermediary. Documents all Prior Authorizations and/or Referral in appropriate systems. Interviews patients or their representatives in person or by telephone and accurately enters information required for the Clinic registration into Meditech assuring all information is complete and accurate. Requires knowledge of CPT codes and ICD-10 codes. Distributes information to the Specialty Clinics. The highest regard for patient confidentiality is an expectation at all times. Acts in a professional manner and puts patient needs first.
Secures all required prior authorizations for all Neurology, Cardiology, High end Radiology, Pain injections and surgery. Works denials when needed.
Responsible for interviewing patients or their representative, obtaining personal information or verifying information already on file, including emergency numbers, next of kin, employer and insurance information to bring accounts to a full registration.
Secures all referrals for outpatient clinic visits as needed.
Verifies insurance eligibility and benefits and obtains and/or verifies authorization when required at least 5 days prior to the date of service. Notifies patient of self pay responsibilities.
When required, contacts the ordering provider for more detailed clinical information to support the required procedure.
Required Qualifications:High School diploma or GED required.
3-5 years related work experience required in hospital financial setting.
Ability to work independently with minimal supervision.
Experience with computer systems required, including web based applications and some Microsoft Office applications which may include Outlook, Word, Excel, PowerPoint or Access.
Preferred Qualifications:Understanding of hospital collections.
Competencies:Decision Making: Ability to make decisions that are guided by general instructions and practices requiring some interpretation. May make recommendations for solving problems of moderate complexity and importance.
Problem Solving: Ability to address problems that are varied, requiring analysis or interpretation of the situation using direct observation, knowledge and skills based on general precedents.
Independence of Action: Ability to follow precedents and procedures. May set priorities and organize work within general guidelines. Seeks assistance when confronted with difficult and/or unpredictable situations. Work progress is monitored by supervisor/manager.
Written Communications: Ability to communicate clearly and effectively in written English with internal and external customers.
Oral Communications: Ability to comprehend and converse in English to communicate effectively with medical center staff, patients, families and external customers.
Knowledge: Ability to demonstrate full working knowledge of standard concepts, practices, procedures and policies with the ability to use them in varied situations.
Team Work: Ability to interact respectfully with other employees, professional staff and/or external contacts to offer ideas, identify issues, obtain information or deliver services.
Customer Service: Ability to provide a high level of customer service to patients, visitors, staff and external customers in a professional, service-oriented, respectful manner using skills in active listening and problem solving. Ability to remain calm in stressful situations.
Physical Nature of the Job:
Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally