Purpose of Position:

The purpose of this position is to reduce denials through proactive practices.  

Skills and Qualifications:

High school graduate, minimum Comprehensive knowledge of Patient Access process, Clinical Care process and Revenue Cycle   Knowledge of medical terminology and managed care concepts preferred Experience in CPT and ICD coding preferred  Refined communication skills, both written and oral Ability to cope with the stress of the position and deadlines imposed Refined organization skills with a well-developed style of diplomacy Ability to function independently, displaying personal integrity and always maintaining confidentiality Professional manner and appearance in accordance to the Aultman Hospital policies Comprehensive knowledge of computer and the software systems utilized by the clinical, registration and patient financial services departments

 

Primary Responsibility:

Verify the payer source of all inpatient and OBV patients Determine eligibility and benefits Coordinate all authorizations and pre-certifications by directly contacting payer Mange all outpatient prior authorization requirements for all scheduled tests or procedures Provide insurance related information to Case Management and Utilization Management staff Communicate any changes identified in the verification process to the Utilization Management staff to assure proper reimbursement Responsible for Patient Access related denied claims in the Denials Mgmt software system 

 

Job Specific Requirements:

Initiate the verification and pre-certification of insurance benefits as soon as possible post admission or pre admission when possible by electronic eligibility systems, payer website or telephone Convey required information to third party payers to meet requirements ensuring  payment for services Work cooperatively with physicians offices to obtain necessary information Contact payers and/or phys offices to secure prior authorization for scheduled procedures Accurately record information in MPAC system as a method of communication with PFS to facilitate correct billing of services Communicate any issues of patient financial concerns to the Patient Outreach department Function as a team member, working closely with the Utilization Management specialist, Case Managers and Social Workers to promote positive patient outcomes Identify areas for inter and intradepartmental operational improvements