Obtain and secure prior authorization for high end procedures,hospital scheduled admissions and/or specialty patients. Verifies and completes insurance verification on such studies to ensure patient has coverage prior to appointment date. Establish and maintain communication with all necessary providers, nurses, and office staff to ensure completion on all peer to peer review and denials. Acts as a liaison for all financial matters to insurance companies, departments and patients.
Acts as coordinator between all Revenue Cycle teams and departments, Utilization Management and Care Management, Providers, various departments, clinical departments and the patients concerning activity services which are ordered by all Geisinger providers regardless of the facility.
Completes precertification using appropriate review criteria.
Establish and maintain communication with all Providers, Nurses, and office staff to ensure completion on all peer to peer reviews and denials.
Conducts research and follow-up activities on assigned accounts according to established procedures and time frames.
Ability to understand and strive to meet targets; decrease overall Accounts Receivable over 90 days, increase Cash and effectively work through and assist patients and providers with the Discounting Policies and Bad Debt Policies.
Submission of predetermination forms for prior approval and coordination for the patient, as appropriate.
Assists physicians, insurance companies, employers, and others with requests concerning prior authorization to result in positive resolution.
Coordinates efforts with other departments to resolve financial clearance, insurance, billing, collection, and other related concerns and issues.
Completes and updates hospital account notes for all accounts reviewed.
Works various reports to ensure all scheduled procedures were completed prior to service for all Geisinger facilities.
Provides information to all team members and direct manager regarding insurance company updates as appropriate regarding updates, system enhancements, insurance updates, etc.
Advises supervisor and direct manager of unusual situations, chronic financial and medical and legal problems.
Recommends process improvement to increase efficiency in area of responsibility.
Responsible to be available to answer patient questions pertaining to status of precertification.
Ability to effectively assist with billing in regards to precertification or coding changes that need to occur for claim resolution.
Responsible for timely completion of the ABN process to ensure services rendered at the time of the procedure are reimbursed.
Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
High School Diploma or Equivalent (GED)- (Required)
Minimum of 2 years-Related work experience (Required)
Certification(s) and License(s)
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.
We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh FoodFarmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencingprograms, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 1...3 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers. What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.