Work Shift:

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Position Overview:

MINIMUM REQUIREMENTS

Education: High school diploma or GED.

Experience: Two years of scheduling, insurance, authorization or billing related experience in a healthcare related setting. Medical office training or medical certification accepted in lieu of experience.

Other Credentials:

Knowledge and Skills: Strong verbal and written communication skills. Excellent interpersonal and organizational skills. Knowledge of insurance authorization/referral requirements preferred.

Special Training: Proficient computer and telephone skills. Familiarity with medical terminology.

Mental, Behavioral and Emotional Abilities: Ability to problem solve and multi-task.

Usual Work Day:8 Hours  

ESSENTIAL FUNCTIONSWorks collaboratively with scheduling, clinical and data entry staff to fully understand patient scheduled and completed visits, and the status of each patient’s insurance.Gathers all necessary paperwork and contacts insurance company for authorizations and referrals as appropriate prior to dates of service by phone or electronic communication.Obtains accurate and valid authorizations and referrals from various insurance companies prior to dates of service.Obtains and advises patients of all necessary authorizations and referrals needed to ensure financial reimbursement.Communicates authorization and referral status to scheduling and clinical staff.Contacts insurance company for an updated authorization that reflects the actual services performed expediently.Communicates all authorization issues and concerns to management, and actively participates in authorization-related problem resolution.Maintains a current and thorough understanding of payer requirements related to authorizations and referrals for medical services.Performs all medical reception scheduling duties, including answering phones, scheduling appointments, making PAT reservations, contacting patient to confirm scheduled appointments, and notifies patient logistics of routine admissions for scheduled outpatient procedures.Gathers complete patient and procedure information and collaborates with physician's office to schedule cases while negotiating dates and times avoiding resource conflicts.Works with directors to schedule physician specific cases to maximize efficiency and productivity and coordinates the peer to peer authorization process when authorizations are denied.Works with the interventional staff and clinical financial specialist and acts as a resource for department on any issues related to interventional coding and billing adjustment based on audits and CMS edits.Works with the clinical team member, financial specialist, and department leadership to create and update procedural CDM codes as needed.Assists Medical Records, Corporate Compliance, or Finance with appeals process by providing necessary documentation.Performs other duties as assigned.

Offers are contingent upon successful completion of our onboarding process and pre-employment physical.  Capital Health will require all applicants (including contractors, travelers and consultants) to have an annual flu vaccine prior to start date, with the exception of individuals with medical and religious exemptions.

"Company will never ask candidates for social security numbers or date of birth during application phase. If you are asked for this information online, you may be a target for identity theft."