Serve as day-to-day lead for direct reports providing regular and timely mentorship and performance coaching. This includes having regular staff 1:1s, conducting performance reviews, creating development plans with support of department manager, assisting with hiring, handling administrative supervisory duties such as timesheet approval, time-off requests, and scheduling management.
Provide supervision to team of direct reports and serve as a point of escalation for hands-on research and resolution of more complex usage issues and/or escalated concerns.
Interact with support leadership and staff team members and ensure appropriate information is obtained to perform roles and drive timely solutions.
Identifies patient pre-authorization/referral requirements and ensures they are met and in place in a timely manner to facilitate efficient billing and payment for multiple specialties
Tracks and follows up on all pending authorizations depending upon payer guidelines
Processes authorizations in a variety of methods, working with the payers to secure authorizations
Verifies authorization quantities and effective dates are returned and processed correctly by the payers, and loaded correctly in all systems
Organizes work to avoid lost revenue due to filing limitations
Identifies opportunities to improve authorization efficiencies electronically via Availity, payer portals, etc.
Reviews Outpatient and Inpatient accounts to identify if notification, authorization and/or referrals are required and obtains prior to service being rendered and within payer guidelines
Reviews and submits authorization, referrals, and other medical necessities timely to ensure that patients can keep scheduled appointments, while following departmental procedures
Facilitates timely telephone calls and online inquiries regarding status of outstanding referrals and/or authorizations and notifications
Reviews, rectifies, and clears individual and batch Worklist errors and alerts to ensure account quality and accuracy
Identifies accounts that have been postponed or cancelled and removes authorizations that are no longer valid and request updated authorizations
Troubleshoots insurance denials and billing discrepancies and prepare paperwork for appeal submission regarding prior authorizations.
Qualifications
Work experience in both billing and collections.
A minimum of one year in Patient Access/Patient Registration, Patient Accounts, or a physician\xe2\x80\x99s office in which the candidate directly managed verification of eligibility, obtaining referrals and authorizations, and/or registration of demographic and insurance information.
Knowledge, Skills and Abilities
Knowledge of and ability to explain concepts of medical benefit plan design
Excellent organizational, teamwork, and time management skills
Highly motivated and detail-oriented
Good troubleshooting skills
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