Job Description
Purpose of Position: To financially clear all scheduled patients within 48 hours of their cardiac test and/or procedure. Resolve issues with accounts due to errors with authorizations, registration, and eligibility. The job responsibilities include working effectively with the interdisciplinary team of Physician Offices, Insurance Companies, and CCHC Revenue Cycle to assure the protection and recovery of all revenues associated with services provided by MACC/CCHC. Point person for day-to-day financial activities at the practice, including obtaining prior authorizations, medical records, supporting the front office as needed, and other administrative tasks. Assist with the review, analysis, development, and implementation of Process Improvement changes for the practices to improve efficiency and workflow.
Description:
* Validates daily cardiology testing assignments using standardized protocols, DAR, and work queues to ensure timely completion of financial clearance in accordance with departmental processes and payer guidelines utilizing all necessary Epic applications.
* Verifying insurance eligibility using available technologies, payer websites, or by phone contact with third-party payers, working in accordance with required State and Federal regulations and CCHC policies.
* Contacts patients as needed to gather demographic and insurance information and updates patient information within the EMR as necessary.
* Ensure correct insurance company name, address, plan, and filing order are recorded in the patient accounting system. Notify Operations Manager/Practice Manager of any errors or concerns.
* Utilize payer websites and/or Epic/Experian to process, obtain, and verify insurance authorizations.
* Using the incoming referral work queue, request, obtain, and link insurance referral authorizations to upcoming cardiology tests as outlined by the patient’s insurance plan in a timely manner.
* Tracks, documents, and communicates the status of authorizations as they move through the workflow process, ensuring proper follow-up, documentation, and communication when the authorizations have been completed.
* Manages numerous authorization requests concurrently without impacting quality.
* Follow-up and work registration/authorization claim denial work queues to identify and take appropriate action to fix errors for claim resubmission to payers.
* Document all actions taken on accounts with clear and concise notes.
* Work with Operations Manager/Practice Manager to continuously identify and correct issues identified by reporting.
* Participate with Managers in strategizing for Process Improvement initiatives to improve cash flow.
* Maintain close coordination with Operations Manager/Practice Manager, Clinical/Front End staff, and Physicians to facilitate appropriate care and services in relation to insurance payer requirements.
* Ensure that incoming calls are handled in an efficient, professional manner, responding back to patient inquiries in a timely manner.
* Responds to all practice inquiries and questions about prior authorizations and insurances.
* Maintain core competency and current knowledge of regulatory and payer requirements to perform job responsibilities.
* Assist the department, work unit, and/or fellow staff members by cross-covering for absences, participating in special projects, and attending ongoing training sessions, etc.
* Attends and participates in educational programs, in-service meetings, workshops, and other activities as related to job knowledge and state guidelines.
* Assume accountability for other practice projects under the direction of the Operations Manager.
* Ability to work with minimum supervision and in a team environment.
* Assist with cardiology coverage when the manager is off.
* Performs other job-related duties and assignments as requested/directed.
* Demonstrates the ability to adjust to unexpected changes to assure all responsibilities/duties are met during absences or increases in work volume.
Qualifications:
* Certified in Medical Office Administration strongly preferred; High School diploma or GED required.
* Ability to read, write, and communicate effectively in English.
* At least one (1) year experience with current Revenue Cycle Department with emphasis on Patient Access and/or Scheduling is strongly desired.
* Experience with office technology, proficient with medical computer office applications (Electronic Medical/Health Records, MS Office, etc.), Epic preferred.
* Demonstrated/documented attention to detail and persistence in completing tasks.
* Excellent interpersonal, problem-solving, and critical thinking skills.
* Excellent telephone and customer service skills.
* Experience in computerized and manual insurance referral/prior authorization and the use of payer websites and related paperwork.
* Experience in a medical office with 1-2 years’ experience in dealing with Managed Care, HMO’s, and the administrative policies.
* Medical Terminology knowledge preferred.
Schedule Details: 80 PP (40 hrs per week), Mon-Fri, 8a to 4p, No weekends & No Holidays
Organization:
Medical Affiliates of Cape Cod
Primary Location:
Massachusetts-Falmouth
Cape Cod Healthcare has been made aware of an instance in which a potential scammer has attempted to impersonate CCHC leadership and request chat interviews. Please note this is not our process and we will never direct you to interview solely through web-based chat. For any questions about available job opportunities or to learn more about our interview process please visit our careers page: https://www.capecodhealth.org/careers/
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