Description
Purpose:
Verifies insurance coverage and authorizations have been obtained for all scheduled ancillary services prior to date of service.
This position will work 8-hour shifts Monday to Friday, during one of the following: 7:30 a.m. to 4:00 p.m. or 8:00 a.m. to 4:30 p.m. The shift will be determined at the time of hire. Strong preference given to applicants who have graduated from a Medical Assistant program and previous experience with insurance authorization.
Responsibilities:
- Search continuously for improvement opportunities and notifies the supervisor and/or team leads of trends.
- Follows up on physician office and/or patient concerns or questions.
- Maintains knowledge of third party requirements (referrals, prior authorizations, notification forms, COB, HMO, Worker's Compensation, Auto Insurance and Managed Care contracts) and insurance compliance.
- Refers uninsured patients, who are unable to pay, to the financial counselors.
- Knowledge of diagnosis correlation with anatomical study scheduled. (Including contrast levels)
- Acts as a liaison to technologists, physician offices, and other departments for scheduling and authorization directions.
- Acts as a liaison to health center staff regarding billing questions as well as any changes health center staff need to make to a patients' account to ensure acceptance of a claim.
- Knowledge of insurance plans UPMC Pinnacle sites participate with.
- Continuing education with insurance plan changes and referral/authorization guidelines.
- Educate referring physician offices on how to obtain authorizations or referrals.
- All verification is completed daily.
- Accounts are completed in a timely manner to improve customer satisfaction and allow for referral and authorization activities prior to patient's arrival.
- Enters authorization information onto HAR in Epic.
- Gathers and/or verifies insurance information. Resolves complex insurance verification questions.
Qualifications
- Associate's Degree or equivalent with a minimum of 1-year experience with insurance verification/authorization or closely related field.
- In lieu of degree a minimum of High School diploma or equivalent with 2-3 years experience with insurance verification/authorization or closely related field.
- Working knowledge of basic medical terminology and completion of medical terminology course within six months of employment with passing score of 80%.
- Excellent verbal and written communication skills.
- Working knowledge of insurance / billing requirements.
- Preferred:
- Prior Epic knowledge preferred
- ICD-10 coding knowledge preferred
- CPT codes for diagnostics procedures
- Strong preference given to applicants who have graduated from a Medical Assistant program and previous experience with insurance authorization.
Licensure, Certifications, and Clearances:
Clearances must be dated within 90 days
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Act 33 with renewal
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Act 34 with renewal
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Act 73 FBI Clearance with renewal
UPMC is an Equal Opportunity Employer/Disability/Veteran
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