Employment Type:Full timeShift:Day Shift

Description:

Responsible for all aspects of the authorization/pre-certification, referral process and identifies amendments/retros to help maximize revenue for departments when CPT (Current Procedural Technology) codes for technologies and services change. Assists in maintaining charge review and claim edit registration work queues and identifying trends to optimize workflows/education needed.

ESSENTIAL FUNCTIONS

1. Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions. Contacts insurance companies via appropriate methods and obtains pre-certifications and authorizations.2. Obtains urgent authorizations same day, next day.3. Verifies correct procedural and diagnostic codes and insurance verification.4. Monitors in basket, email, and fax server if applicable. Follows up on correspondence timely and accurately.5. Monitors authorizations or denials and follows up, as necessary.6. Generates authorization information for physicians, patients, and health plans.7. Obtains pre-certifications, insurance, and testing authorizations for medical procedures.8. Communicates denials to appropriate staff and next steps.9. Acts as a liaison among providers, staff, health plan administrators and hospital representatives.10. Relays clinical information to health plan case managers for special procedure pre-certification and out-of-plan or out-of-network referrals; monitors authorizations or denials and follows up, as necessary.11. Communicates referral status to staff and physicians; ensures that authorizations have been processed accurately and in a timely manner to coincide with patient treatment plan.12. Assists offices in resolving billing discrepancies and any other referral/authorization issues.13. Participates in revenue targeted projects and addresses opportunities and barriers as they arise.14. Answers incoming calls.15. Supports other offices, attends required meetings and training, performs research, e-learning to stay current on best practices and participates in committees as requested.16. Handles amendments and retro-authorizations to recoup revenue.17. Handles retro-authorizations in the retro-authorization work queue.18. Identifies opportunities to prevent denials future state.19. Responsible for PB REG Newborn Review work queue.20. Resolves issues in the Hospital PB REG Charge Review and Claim Edit work queues.21. Assists with special projects and assumes additional duties as assigned. Scans and files documents.22. Maintains a working knowledge of applicable Federal, State, and local laws/regulations, the Trinity Health’s Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

MINIMUM QUALIFICATIONS

1. High school diploma. Must possess a minimum of three (3) years of experience with insurance referrals, prior authorizations, or other equivalent knowledge of professional revenue cycle.2. Knowledge of medical terminology and procedures at the level needed to perform responsibilities.3. Proficient knowledge of major health plans and insurance processes.4. Excellent communication skills in both written and verbal forms, including proper phone etiquette and face to face interactions. Ability to speak before groups of people, either inperson or virtually. Ability to effectively explain relevant insurance information to patients and interact with insurance plans and internal customers. 35. Proficient/knowledgeable in-patient care procedures and organizational policies related to position responsibilities.6. Service-oriented; responsive to customer needs and courteous in approach. 7. Proficient in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, NextGen, PowerChart, EPIC, Microsoft Word /Excel/Outlook, intranet and computer navigation.8. Ability to compute mathematical calculations.9. Ability to work independently and collaboratively in a team-oriented environment; displays professional and friendly demeanor.10. Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, patients, family members, vendors, outside customers and couriers.11. Accountable for assigned tasks, prioritizes work with/without leader input and moves projects to completion in a timely manner.12. Good organizational and time management skills to effectively juggle multiple priorities and time constraints.13. Ability to exercise sound judgment and problem-solving skills.14. Ability to handle patient and organizational information in a confidential manner.15. Helps to identify problems, offer solutions, and participate in their resolution. 16. Ability to travel to other office/practice sites and meeting and training locations.17. Successful completion of competency-based program within introductory and training period.18. Must be comfortable operating in a collaborative, shared leadership environment.19. Must possess a personal presence that is characterized by a sense of honesty, integrity and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

Our Commitment to Diversity and Inclusion
 

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.