Insurance Pre-Cert Coordinator - Outpatient Infusion Services, at Perelman Center, FT Hybrid

Responsibilities

• Review chemo schedule in advance and determines patients insurance requirements for pre-cert, patient payments, coverage limitation and determine necessary action prior to patient arrival.
• Assess information for appropriateness of setting and utilization of resources to optimize patient outcomes and cost effectiveness.
• Maintain communication with provide education to all involved departments included but not limited to admissions, business office, case managers and medical staff and designees.
• Provide required clinical and demographic information to payer to obtain precertification and assure reimbursement.
• Communicate with patients to verify incomplete insurance information and remind the HMO patients to obtain a referral and make patient aware of any co-pays.
• Pre-certify and obtain authorization numbers and enter into Epic insurance flowsheet.
• Obtain medical, ICD-9 and CPT codes.
• Interact with medical staff and their designees to obtain complete, accurate, timely clinical and financial information required for payer reimbursement.
• Fax all information required to insurance companies to ascertain an authorization number for pre-cert.
• Keep representatives apprised of any changes in the process.
• New and improved methods of obtaining insurance authorizations Internet, envoy.
• Follow up with all review companies on all pending authorizations and referrals.
• Checks-in/arrives patient appointments daily in Epic.
• Pre-register appointments 24 hours in advance of patient's appointment.
• Maintain excellent working relationships with all insurance companies.
• Communication and maintain excellent working relationships with referring physicians and their staff.
• Work approximately one week in advance whenever possible.
• Provide accurate information to billing and case management to assure payment of claims.
• Willingly accepts responsibility and demonstrates positive and competent performance.
• Provides ongoing education and exhibits a willingness to share current knowledge with team members as necessary to help meet organizational goals.

Qualifications

• H.S. Diploma/GED (Required)
• Education or Equivalent Experience: 3+ years experience in a healthcare environment or education in lieu of experience (Associate's or Bachelor's degree)

Benefits

Penn Medicine offers a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region.