The following information is intended to be representative of the work performed by incumbent in this position and is not all-inclusive. The omission of a specific duty or responsibility will not preclude it from the position if the work is similar, related or a logical extension of position responsibilities. Demonstrates, by actions, commitment to the mission and the behavioral standards of SIU School of Medicine. Provides excellent service to both internal and external customers through collaboration and partnership; compassion and respect; integrity and accountability; diversity and inclusion; as well as continuous learning and improvement.
MANAGEDCARE DUTIES 85%
A. Maintains referral queue, Worklist, Referral/precertification, and financial authorization task boxes ensuring timely completion, tracking and documentation of necessary referral/pre-certifications for the Department of Obstetrics and Gynecology and SIU Fertility and IVF Center.
B. Work good faith estimate report and daily schedule.
C. Performs pre-certification of surgeries/procedures to ensure that proper authorizations or approvals are received prior to service.
D. Provides proper consent documents to hospitals to ensure that all necessary paperwork is in place prior to date of service.
E. Correspond with insurance companies, Medicaid and Medicare, as required to identify and collect the correct information for entry into the patient database for billing purposes.
F. Receive and respond to calls from patients regarding the status of insurance claims, pre-certifications, authorizations, billing questions, etc. Also respond to physicians, hospitals, insurance companies, government agencies and related interested parties as it pertains to the resolution of claim reimbursements
G. Respond to inquiries from physicians, nurses, hospitals, government agencies, insurance companies, managed care companies and patients concerning requests for assistance to assure appropriate coverage for planned medical services.
H. Process patient requests for completion of FMLA and disability forms for the Division of Reproductive Endocrinology.
I. Compiles insurance benefits and creates/maintains updated insurance verification sheets
for the SIU Fertility and IVF Center. Flag appointments that need correct or updated insurance verification.
J. Discuss insurance benefits or lack there of with ALL new patients within SIU Fertility and IVF Center. Explain cash payment option and prices to All patients who do not have coverage.
K. Ensure referrals are in place for patient appointments with insurance companies when necessary.
L. Interacts with physicians, residents, nurses, and insurance carriers to resolve problems concerning billing issues.
M. Keep abreast of financial programs throughout County/State/Federal to better serve patient's needs ie:, IBCCP
N. Assist in any Donor/Surrogate and Outside Monitoring questions.
ADMINISTRATIVE 15%
A. Attend training sessions, meetings and conferences and read publication store main current on the policies and procedures of managed care/insurance companies.
B. Maintain list of managed care contacts for each organization and insurance company.
C. Participate in the development of appropriate forms for internal and external use as ,t relates to referrals and pre-certs.
D. Attend staff meetings as necessary.
E. Other duties/projects as assigned.
SKILLS AND ABILITIES NEEDED FOR THE POSITION:-
Ability to type accurately.
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Ability to follow verbal instructions and complex written directions.
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Ability to complete and process forms, selecting data from various sources.
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AbilitytounderstandandlearntheclinicalcomputingsystemusedbySIUMedicine.
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Knowledge of the precertification/preauthorization process.
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Excellent communication skills in dealing with patients, Department staff, managed care/insurance personnel and physicians. Maintain professional demeanor in interactions with all individuals, internal and external to the organization.
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Ability to handle stressful situations.
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Excellent organizational skills and abilities to multi-task and prioritize assignments.
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Basic Familiarity with and understanding of ICD-10 material and CPT guidelines.
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Experience with Managed Care insurance plans, understanding the mechanisms and processes of referral, authorization, approval, and pre-certification, including knowledge of Managed Care requirements, as well as, other payer reimbursement demands.
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Familiarity with Medicare, Medicaid, Managed Care and Commercial Insurance payers, complying with the various requirements to enhance reimbursements.
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Sensitive to the needs of under represented minority populations.