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Salary Responsible for the accurate collection of pre-certifications and/or authorizations for OP procedures. This position will work closely with the Central Scheduling department, the Physician's office, the Insurance companies and the Business Office to ensure that all authorizations are obtained in a timely manner. Customer Service is very important in all communications.
The incumbent is also responsible for management of claims through the process of submission of both electronic and paper-based claims, resolution of claim edits / validation of data integrity, and resolution of claims for all commercial and government health insurance payers submitted on behalf of MERCY REGIONAL MEDICAL CENTER in accordance with established standards, guidelines and requirements. The incumbent conducts follow-up process activities through websites, phone calls, fax and written correspondence, leveraging work queues to organize work efficiently. Work also includes reviewing insurance remittance advices, researching denial reasons and resolving issues through well-written appeals. Work requires proactive troubleshooting, significant attention to detail and the application of analytical/critical thinking skills to analyze denials and reimbursement methodologies and bring timely resolution to issues that have a potential impact on revenues. Additionally, the incumbent must be able to communicate effectively with payer representatives and maintain professional communication with team members to support claim/denial resolution.
Requirements:- Must be able to type.
- Ability to work without close supervision.
- Ability to communicate effectively in English, both verbally and in writing.
- Professional communication skills.
Skills:
- Word processing experience helpful. Computer operation, including knowledge of Excel preferred.
- Ability to set priorities, coordinate multiple tasks, organize tasks, and maintain control of workflow.
- Ability to work under stressful situations.
- For physical demands of position, including vision, hearing, repetitive motion and environment, see following description.
