Responsible for the provision of complex activities surrounding obtaining appropriate medication authorizations from payors. Utilizing appropriate workflow to assure zero authorization errors, efficient operations, and creating expeditious reimbursement opportunities and optimal customer satisfaction.
* Clerical functions include but are not limited to the management of phone lines, faxing, documentation of information received by phone or fax, retrieval of medical records, scanning of documents and other clerical functions not listed.* Collect insurance benefit information from insurance representative or web portal to make determination of patient's insurance benefits and coverage options.* Enter data into EHR in an accurate manner that assures resolution to patient claims when processed.* Performs routine medication authorization processes, including coverage eligibility, insurance verification, and authorization requirements, resolving any issues with coverage and escalates complicated issues according to supervisor/manager.* Demonstrates the components of the Children's Health System Vision, Mission and The Children's Way Values* Possesses the ability to interpret and demonstrates compliance with performance standards, regulations and policies and procedures and third-party contracts, guidelines* Participates in team-oriented process improvement initiatives for the department and organization* Follows all safety rules while on the job, reports accidents promptly and corrects minor safety hazards* Continually communicate with and advocate for patients and families, Providers, multidisciplinary team members and payers to facilitate coordination of submissions and approvals* Punctual notification to physicians, clinical staff and customers regarding additional requested information from payor regarding medications authorizations to reduce approval delays. (i.e. Peer to Peer, letter of medical necessity, document signatures)* Work collaboratively with others to define and study areas of inefficiency and participate in process improvement projects* Demonstrate understanding of departmental metrics and key performance indicators used to measure work performance and departmental effectiveness in reached desired results.* Stays abreast of payor guidelines and standards* Proactively seeks to understand areas/roles outside of immediate area/role within department* Performs all other duties as assigned
Work Experience: At least 2 years customer service experience with two years of healthcare experience including insurance verification and/or billing required. Education: Two-year Associate's degree or equivalent experience required. Licenses and Certifications: National Association of Healthcare Access Management CHAA Certification preferred. Healthcare Financial Management Association CRCR Certification preferred.
A Place Where You Belong: We put our people first. We welcome, value, and respect the beliefs, identities and experiences of our patients and colleagues. We are committed to delivering culturally effective care, creating meaningful partnerships in the communities we serve, and equipping and developing our team members to make Children's Health a place where everyone can contribute.