Founded in 1906, McLeod Health is a locally owned and managed, not for profit organization supported by the strength of more than 900 members on its medical staff and more than 2,900 licensed nurses. McLeod Health is also composed of approximately 15,000 team members and more than 90 physician practices throughout its 18-county service area. With seven hospitals, McLeod Health operates three Health and Fitness Centers, a Sports Medicine and Outpatient Rehabilitation Center, Hospice and Home Health Services. The system currently has 988 licensed beds, including Hospice and Behavioral Health. The hospitals within McLeod Health include: McLeod Regional Medical Center, McLeod Health Dillon, McLeod Health Loris, McLeod Health Seacoast, McLeod Health Cheraw, McLeod Health Clarendon and McLeod Behavioral Health.
Essential Job Responsibilities/Expectations
1. Superior knowledge of insurance payers and medical terminology including clinical documentation, ICD-10 code(s) and CPT code(s).
2. Proactively completing assigned pool of patients initiating and finalizing the authorization with the patient payer(s). This includes submitting authorization requests via telephone, facsimile or via the payer web portals.
3. Proactive and frequent communication with Case Management, physician practices, etc. to ensure the patient is worked timely.
4. Detailed documentation of all patients worked including Caller ID, if applicable, validity dates, the authorization number, if pending/explanation or denied/explanation.
5. Should authorization be denied, proactive outreach to procedural Scheduling and/or facility Financial Counselor so patient can be rescheduled and/or financial terms discussed.
6. Excellent follow through ensuring that patients with pending authorizations are checked again next business day and thereafter until the authorization is secured.
7. Willingly assists others to ensure all patients are worked in a timely manner at least 5 business days prior to date of service.
8. Proactively investigates and researches issues at a high level to ensure the patient has been financially vetted thereby ensuring patient satisfaction and hospital reimbursement.
9. Engages the physician practices, when needed, if peer-to-peer is required or additional clinical documentation is needed by payer.
10. Maintains a professional image and exhibits excellent customer relations to patients, visitors, physicians, and co-workers in accordance with our Service Excellence Standards and Core Values.
11. Scope of work supports McLeod Health Florence, Cheraw, Clarendon, Dillon, Loris, Seacoast, and Carolina Forest.
Job Requirements
Qualifications/Training:
• Advanced knowledge of Windows based computer systems
• Written and verbal communication skills with persons of all ages and diverse backgrounds
• Preferred 2 years’ experience in call center, medical office, or insurance related field
• Problem solving and performance improvement skills
• Revenue Cycle knowledge and the understanding of how this work impacts such
Licenses/Certifications/Registrations/Education:
• Minimum of a High School Diploma/GED from an accredited school