Summary

Delegates and monitors staff work assignments in the absence of department supervisor. Assists supervisor with team quality assurance reviews, provider peer to peer/appeal follow up and all clinical department as well as facility communications. Provides pertinent information to patients and departments while maintaining good rapport. Handles complex requests for high level specialties and services.

This position is located in Greenway Plaza.

Job Duties

• Responds to and assists physicians with patients questions.
• Obtains benefits, creates estimates for patient out of pocket, and submits authorizations for services.
• Follows up on submitted authorizations, notates authorization in appropriate area in Epic for all services.
• Contacts patients to collect out of pocket expenses.
• Contacts departments regarding missing clinical information if required by insurance company.
• Contacts PCP offices to obtain referrals.
• Understands high level specialty services authorizations and pre determinations.
• Updates referral statuses and collection efforts in Epic.
• Monitors Insurance Verification Helpline and delegates or respond to patient, physician, and department inquiries.
• Responds to complex account inquiries by management.
• Communicates directly with clinic departments.
• Creates estimate letters that are electronically forwarded to patients to inform them of their financial responsibility.
• Investigates insurance coverage and demographics.
• Researches claims denied for no authorization and performs retro authorizations.
• Answers phones and provides information to patients or takes detailed messages.
• Preceding duties account for approximately 50% of the Revenue Cycle Specialist Duties.
• Works directly with the supervisor and has the ability to step in as Acting supervisor if needed.
• Assists the supervisor with team member QA's.
• Assigns work to staff, and monitors their progress throughout the day.
• Is proficient in guidelines for Medicare, Medicaid and commercial payers pre authorization requirements.
• Analyzes trends and issues and suggests possible resolutions.
• Performs other job-related duties as assigned.

Minimum Qualifications

• High school diploma or GED.
• Three years of relevant experience.

Preferred Qualifications

• Epic experience.
• Multi-specialty verification and authorization submission experience.
• Revenue Cycle Team Lead or supervisory experience.