Company : Allegheny Health Network Job Description : 

GENERAL OVERVIEW:

Completes all scheduling/pre-registration functions, verifies health insurance coverage, obtains detailed benefit information, validates authorization, calculates, collects and posts patient liabilities. Communicates revenue cycle related issues as needed. Contacts patients/physician offices, case managers and/or social workers to obtain complete and accurate demographic and insurance information. Assumes clinical and financial risk of the organization when collecting and documenting information on behalf of the patient. Completes daily reporting including productivity, quality control, authorization and denial follow up. Trains and assists other team members.

ESSENTIAL RESPONSIBILITIES:

Utilizes applicable work lists, faxes and phone calls to conduct scheduling/pre-registration functions, provides necessary pre-procedure instructions, validates patient demographic data, performs ABN check to determine medical necessity, verifies and obtains detailed medical benefits, assigns accurate plan code and COB order. Identifies payer specific authorization/referral requirements by service. Provides appropriate documentation and follow-up to physician offices, case management, and payers regarding authorization/referral deficiencies. Verifies all insurance information through payer contact via telephone, online resources, or electronic verification systems. Corrects/updates all necessary data to assure timely and accurate bill submission. Identifies all patient financial responsibilities, calculates estimates, collects liabilities, communicates liability estimation to patient, posts payment transactions as appropriate in the system and conducts daily reconciliation of cash received for management review/sign off. After thorough investigation, identifies self-pay accounts and complex liability pricing calculations and escalates account to financial counselors as applicable. (50%) Maintains focus on attaining productivity standards. Reviews department reports on a daily/weekly basis and resolves outstanding issues as needed. Focuses on productivity, quality control. authorization and denial follow up. Recommends new approaches for enhancing performance levels and quality standards. Communicates team barriers and process flow issues to management. Assists team members with operational support and training. Assists in resolving complex patient issues in a concise and informative manner as required. (25%) Delivers a positive patient experience. Cooperates with and maintains excellent working relationships with patients, AHN leadership, co-workers, physician offices and other internal and external customers, and designated external agencies or vendors. Performs any written or verbal communication necessary to exchange information with designated contacts. (10%) Maintains strict adherence to and compliance with all internal and external policies, procedures, rules, regulations, patient confidentiality and HIPAA privacy laws. Remains current on all regulations, policies and procedures. Incorporates and complies with any process changes that are essential to completing assigned daily tasks. Completes and/or attends mandatory training and educational sessions within approved guidelines and timeframes. (10%) Performs other duties as assigned or required. (5%)

QUALIFICATIONS:

Minimum

2 years with healthcare revenue cycle

Preferred

Associate's Degree Certification with Healthcare Financial Management Association or Certified Revenue Cycle Specialist (CRCS) with American Association of Healthcare Administrative Management Three years’ experience Experience within  financial clearance setting

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:

$18.35

Pay Range Maximum:

$26.03

Base 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 their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

EEO is The Law

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