Insurance/Billing Rep - Interventional - HPW - Full-time - Day

SUMMARY (Basic Purpose of the Job)

Supports the Interventional Service Line by providing patient scheduling. Ensures that all scheduled patient visits have accurate and valid insurance authorizations and/or referrals prior to the date of service. Assists the service line with daily billing, charging, charge corrections when claims are denied, require retro adjustments based on procedural coding and CMS edits.

Minimum Requirements

• Education: High school diploma or GED
• Experience: Two years of scheduling, insurance, authorization or billing related experience in a healthcare related setting. Medical office training or medical certification accepted in lieu of experience.

Other Credentials

• Knowledge and Skills: Strong verbal and written communication skills. Excellent interpersonal and organizational skills. Knowledge of insurance authorization/referral requirements preferred.

Special Training

• Proficient computer and telephone skills. Familiarity with medical terminology.

Mental, Behavioral and Emotional Abilities

• Ability to problem solve and multi-task.

Essential Functions

• Works collaboratively with scheduling, clinical and data entry staff to fully understand patient scheduled and completed visits, and the status of each patient’s insurance.
• Gathers all necessary paperwork and contacts insurance company for authorizations and referrals as appropriate prior to dates of service by phone or electronic communication.
• Obtains accurate and valid authorizations and referrals from various insurance companies prior to dates of service.
• Obtains and advises patients of all necessary authorizations and referrals needed to ensure financial reimbursement.
• Communicates authorization and referral status to scheduling and clinical staff.
• Contacts insurance company for an updated authorization that reflects the actual services performed expediently.
• Communicates all authorization issues and concerns to management, and actively participates in authorization-related problem resolution.
• Maintains a current and thorough understanding of payer requirements related to authorizations and referrals for medical services.
• Performs all medical reception scheduling duties, including answering phones, scheduling appointments, making PAT reservations, contacting patient to confirm scheduled appointments, and notifies patient logistics of routine admissions for scheduled outpatient procedures.
• Gathers complete patient and procedure information and collaborates with physician's office to schedule cases while negotiating dates and times avoiding resource conflicts.
• Works with directors to schedule physician specific cases to maximize efficiency and productivity and coordinates the peer to peer authorization process when authorizations are denied.
• Works with the interventional staff and clinical financial specialist and acts as a resource for department on any issues related to interventional coding and billing adjustment based on audits and CMS edits.
• Works with the clinical team member, financial specialist, and department leadership to create and update procedural CDM codes as needed.
• Affords assistance in the appeals process by providing necessary documentation.
• Performs other duties as assigned.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

• Frequent physical demands include: Wrist position deviation, Keyboard use/repetitive motion
• Occasional physical demands include: Standing, Walking, climbing (e.g., stairs or ladders), Carry objects, Push/Pull, Twisting, Bending, reaching forward, reaching overhead, Squat/kneel/crawl, Taste or Smell, Talk or Hear
• Continuous physical demands include: Sitting, Pinching/fine motor activities
• Lifting Floor to Waist 10 lbs. Lifting Waist Level and Above 10 lbs.

Sensory Requirements

• Accurate Near Vision, Accurate Far Vision, Accurate Color Discrimination, Accurate Depth Perception, Accurate Hearing

Anticipated Occupational Exposure Risks

• N/A

This Position Is Eligible For The Following Benefits

• Medical Plan
• Prescription drug coverage & In-House Employee Pharmacy
• Dental Plan
• Vision Plan
• Flexible Spending Account (FSA)
• Healthcare FSA
• Dependent Care FSA
• Retail Savings and Investment Plan
• Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance
• Supplemental Group Term Life & Accidental Death & Dismemberment Insurance
• Disability Benefits – Long Term Disability (LTD)
• Disability Benefits – Short Term Disability (STD)
• Employee Assistance Program
• Commuter Transit
• Commuter Parking
• Supplemental Life Insurance
• Voluntary Life Spouse
• Voluntary Life Employee
• Child
• Voluntary Legal Services
• Voluntary Accident, Critical Illness and Hospital Indemnity Insurance
• Voluntary Identity Theft Insurance
• Voluntary Pet Insurance
• Paid Time-Off Program