Company :
Allegheny Health NetworkJob Description :
GENERAL OVERVIEW:
This position is responsible for various utilization review support, from initial insurance verification through authorization; including verifying patient benefits and authorization requirements, requesting authorizations, payer communication & follow-up, and processing of incoming payer phone calls and faxes.
This role works in tandem with utilization review nurses through their clinical review process to ensure all patients coming into the health system through transfers, direct admissions, and the emergency department have appropriate documentation and authorization for payment by insurance companies.
ESSENTIAL RESPONSIBILITIES:
Ensures accurate and complete documentation and information on all transfers and admissions, following all payer requirements and applicable timeframes related to insurance verification, notice of admission, and authorization. (45%)
Collaborate with utilization review nurses for timely submission of clinical reviews to payers to obtain authorization for appropriate level of care and length of stay, documenting payer communications in full detail, including all denial details and processes. (35%)
Identifies payer trends and provides feedback to leadership and necessary parties to mitigate denials and improve payer outcomes. (10%)
Communicates with all parties in a professional and collaborative manner to achieve optimal outcomes, ensuring confidentiality of all patient accounts by following HIPAA guidelines. (10%)
Performs other duties as assigned or required.
QUALIFICATIONS:
Minimum
Bachelor's degree in health care related field or relevant experience and/or education as determined by the company in lieu of bachelor's degree
3 years' experience in healthcare environment or related field with exposure to healthcare coding, billing, reimbursement, registration, insurance verification.
Preferred
None
Skills:
Proficient with Epic
Proficient with Microsoft Office products
Strong analytics, organizational, problem-solving, and time management skills
Ability to work independently
Excellent written and verbal communication skills
Excellent attention to detail
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$21.97Pay Range Maximum:
$34.39Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
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