General Summary/basic PURPOSE OF JOB:

This position provides monitoring of inpatient and outpatient accounts to ensure accuracy of submissions and proper authorizations are obtained in order to secure reimbursement. The success is measured by the ability to reduce bill holds. This includes working closely with the clinical team, including the utilization review nurses and the physician advisors. In addition, support and follow-up is done by the insurance verification team. The role includes, but is not limited to, clinical submission to the payers, securing an authorization for the visit type, continuous follow-up with payers for authorizations and/or additional information, and basic reporting for payer specific behaviors. This also requires monitoring of payer trends and the user of Microsoft's office to track and report data for Senior Management.

MINIMUM Education:

• High School Diploma

• Preferred Associates Degree in health care or related field, Business Administration, Health Information Management.

MINIMUM WORK EXPERIENCE:

• A minimum of 4 years prior working experience with insurance payers, case management, insurance verification or appeals. This includes but is not limited to experience working with Physician Advisors, CMOs, and Social Work.

KNOWLEDGE, SKILLS AND ABILITIES:

• Must be proficient in using computer application software such as MS Excel, MS Word and various other office-related applications.
• Excellent verbal and written communication skills.
• Must be able to interact with a diverse client base including patients and their family members; medical center staff; and external parties as required.
• High level of organizational and attention to detail skills.
• The ability to follow-through and ensure tasks are brought to successful completion.

REQUIRED LICENSES, Certificates, Registrations:

• None