Location Address: 60 Memorial Medical Parkway, Palm Coast, Florida 32164
Top Reasons To Work At Advent Health
Work for a healthcare system that believes in âœExtending the Healing Ministry of Christâ
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No State income tax
Competitive Pay and benefits
Under the guidance of the Utilization Review Mgmt Director, this role works in collaboration with authorization/denials RNs and under the general direction of the Director of Utilization Review. This role is responsible to properly verify benefits, obtain authorizations, and perform assigned tasks within 72 hours of the admission date (ER visits) or earlier if possible. Upholds accuracy and ensures proper authorization has been secured prior to or at the time of discharge for observation and inpatient stay visits. Able to multi-task and complete each account within 15 minutes or less. Possesses excellent telephone etiquette and professional speaking while speaking with patients, commercial payers, physician offices, team members, etc. Ensures all benefits, authorization requirements & status, and collection notes are obtained by working with commercial or managed care payers, documenting clearly and thoroughly on accounts in the pursuit of timely reimbursement within certain established timeframes as determined by the Director. Maintains working knowledge of payer guidelines and has familiarity with payer processes for initiating authorizations and follows through accordingly to prevent loss of reimbursement. Actively participates in team workflows and accepts responsibility in maintaining relationships that are equally respectful to all. Adheres to all rules and regulations of all applicable local, state, and federal agencies and accrediting bodies.
PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:
Â· Communicates with all parties (i.e., staff, physicians, payers, etc.) in a helpful and courteous manner while extending exemplary professionalism. Anticipates and responds to inquiries and needs in an assertive, yet courteous manner. Demonstrates positive interdepartmental communication and cooperation.
Â· Demonstrates ability to understand differences between notification, reference, and authorization numbers. Maintains up-to-date concurrent authorizations for in-house patients, utilizing daily commercial authorization reports. Accesses and reviews payer portals for authorization numbers as directed; updates authorization fields within EMR accordingly.
Â· Familiarizes self with basic authorization requirements for assigned payers, based on payer matrix. Assist in ensuring proper patient status authorization, by reviewing patient admission status within the Cerner Care Manager system and matching with the correct authorization. Answers the department phone via dialer and responds to voice mail in a timely manner, routing calls to facilities as appropriate. Expedites communication with insurance contacts to ensure timely authorization is received.
Â· Receives all faxed requests for clinical information from payers; organizes and communicates to the appropriate member of the Case Management and/or Authorization team, as applicable. Follows up to ensure clinical information has been communicate as requested. Monitors daily discharge reports to ensure all patient stay days are authorized. Follows up with insurance carrier to obtain complete authorization. Communicates with the other departments/team members for resolutions of conflicts between status and authorization.
Â· Immediately notifies the Case Management department and/or Authorization RN and/or Denials RN, as appropriate, of any inpatient denials and obtains information from the insurance carrier regarding their concurrent/retrospective appeal process.
Â· Interacts with physicians, physician office personnel, and/or case management departments on an as-needed basis to ensure resolution of pending denials, which have been referred to the physician for peer-to-peer review with the Medical Director of the Insurance carrier.
Â· Provides timely and continual coverage of assigned work area in order to ensure all accounts are completed. Meets attendance requirements, and is flexible during periods of short staffing, and/or high volume.
Â· Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level before releasing account information. Other duties can be assigned based upon business objectives as outlined by the Director
KNOWLEDGE AND SKILLS REQUIRED:
Â· Basic computer skills (i.e., Word, Outlook, Excel, etc.)
Â· Basic medical terminology
Â· Proficient in using multiple computer applications interchangeably
Â· Communicates professionally with an acceptable use of English (speaking, reading, and writing)
Â· Ability to follow oral and written directions
Â· Ability to work independently with limited supervision
Â· Capable of working with people of diverse backgrounds
Â· Excellent customer service skills and great telephone etiquette
EDUCATION AND EXPERIENCE REQUIRED:
Â· High school diploma or GED
Â· Minimum two years experience registration or claims processing
Â· Minimum two years experience with commercial insurance/authorization handling
EDUCATION AND EXPERIENCE PREFERRED:
Â· Four-year college degree in business administration, health services administration or accounting
AdventHealth Greater Orlando (formerly Florida Hospital) is one of the largest faith-based health care providers in the United States. For 150 years, we have carried on a tradition of providing whole-person care that not only addresses patients' physical ailments, but also supports their emotional and spiritual well-being. We demonstrate the same level of compassion and care for our employees as well, doing all that we can to help them realize their full potential – both personally and professionally.