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Form of work
SalaryMajor Responsibilities:
- Collects and accurately documents initial pre-certification/authorization information if available. Initiates the process for obtaining a required referral/authorization if not obtained.
- Works assigned EPIC Scheduled Order Work Queue, following the department’s work flow process on appropriately transferring, deferring or removing orders from the work queue.
- Proactively communicates issues involving customer service and process improvement opportunities to management.
- Maintains excellent public relations with clinical staff as well as demonstrates a willingness and ability to work collaboratively with others for concise and timely flow of information.
- Maintains knowledge of and reference materials for Medicare, Medicaid and third-party payer requirements, guidelines and policies, insurance plans requiring pre-authorization/referral and a list of current accepted insurance plans.
Licensure, Registration, and/or Certification Required:
- None Required.
Education Required:
- High School Graduate.
Experience Required:
- Typically requires 1 year of experience in health care, insurance industry, call center or customer service setting.
Knowledge, Skills & Abilities Required:
- Demonstrated ability to identify and understand issues and problems. Examines data and draws logical conclusions based on information available.
- Knowledge and ability to articulate explanations of Medicare/HIPAA/EMTALA rules and regulations and comply with updates on insurance pre-certification requirements.
- Mathematical aptitude, effective communication skills and critical thinking skills.
- Understanding of basic human anatomy, medical terminology and procedures for application in the patient referral/pre-certification/authorization processes.
- Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals.
- Ability to speak effectively to customers or employees of organization, maintaining a pleasant, professional demeanor.
- Ability to handle sensitive and confidential information according to internal policies.
- Ability to problem solve in a high profile and high stress area, working independently to set and meet deadlines and prioritize work.
- Demonstrated technical proficiency including experience with insurance verification/eligibility tools, EPIC electronic medical record, patient liability estimation tools, Microsoft Office, Internet Explorer and phone technology.
Physical Requirements and Working Conditions:
- Must be able to sit the majority of the workday.
- Exposed to a normal office environment.
- Operates all equipment necessary to perform the job.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
