Collaborates with physicians, patients, and insurance companies to pre-certify medical services and procedures. The goal of which is to deliver quality medical care in the most cost effective manner. Serves as pivotal point for communication among these parties. This position is responsible for assistance in utilization management and related duties by working collaboratively with the multidisciplinary team to achieve desired clinical, service and cost outcomes. The employee assists in ensuring that patients presenting for treatment obtains authorization from third party payers in order to expedite the receipt of full and timely reimbursement. They provide valuable information for consideration in clinical decision-making. The functions of this position exist to promote quality patient care and to prevent costly payment denials and reduce the institution's financial risk. QUALIFICATIONS/KNOWLEDGE/SKILLS/ABILITIES
- Minimum one-year medical office experience or combination of extensive customer service work experience and education in insurance verification, patient registration, and medical terminology.
- Current CPR Certification.
- Experience utilizing computer-based patient information management systems is preferred.
- Knowledge of various software applications including Windows and Cerner., Knowledge of managed care and government healthcare benefits.
- The ability to comprehend third party contractual arrangements.
- Understanding of the third party denial and appeal process.
- Strong interpersonal skills, communication skills and the ability to work independently.
- Strong organizational skills and the ability to lead a process from beginning to completion.
- The ability to communicate and resolve conflict with physicians, other health care team members, employers, community agencies, clients and families.
- Excellent negotiation skills and the ability to facilitate multiple partners in the multi-disciplinary team.
- The ability to identify and communicate cost and quality issues related to patient care.
- Strong analytical and critical thinking skills.
Ball Memorial Hospital - 20 months ago