Description

Responsibilities

• 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• Identifies accounts that have been postponed or cancelled and removes authorizations that are no longer valid and request updated authorizations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’s 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