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Role Description
• Ability to complete insurance verification and eligibility checks.
• Ability to collect and accurately document initial pre-certification/authorization information if available.
• Initiates the process for obtaining a required referral/authorization if not obtained.
• Ability to work assigned Epic work queue, following the department’s workflow process on appropriately transferring, deferring, or removing orders from the work queue.
• Ability to proactively communicate issues involving customer service and process improvement opportunities to management.
• Maintains excellent public relations with patients, patient's families and clinical staff.
• 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.
• Ability to update the patient, physician's office, and any necessary parties regarding responses and outcomes of the prior authorizations.
• Ability to act as a liaison between physician's office, patient, and pharmacy benefit manager to initiate and resolve appeals, as needed.
Qualifications
• High School Graduate.
• Typically requires 1 year of experience in health care, insurance industry, pharmacy, or medical background.
Requirements
• Demonstrated ability to identify and understand issues and problems.
• Knowledge and ability to articulate explanations of Medicare/HIPAA/EMTALA rules and regulations.
• 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 speak effectively to customers or employees of the 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.
Benefits
• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training.
• Premium pay such as shift, on call, and more based on a teammate's job.
• Incentive pay for select positions.
• Opportunity for annual increases based on performance.
• Paid Time Off programs.
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability.
• Flexible Spending Accounts for eligible health care and dependent care expenses.
• Family benefits such as adoption assistance and paid parental leave.
• Defined contribution retirement plans with employer match and other financial wellness programs.
• Educational Assistance Program.