Responsible for obtaining precertification/ prior authorization and medical necessity review for each patient in which testing or procedures have been scheduled across GHS including but not limited to High End Radiology testing, infusions/injections, oral medications, chemotherapy and/or radiation treatments, sleep studies, genetic testing,cardiology testing and hospital outpatient testing/procedures. Possesses solid knowledge of insurance verification, payor guidelines, ICD-10 coding and gathering of clinical documentation from Electronic Medical Record prior to initiating precertification. Establish and maintain professional, positive communication with all necessary GHS and outside physicians, clinical and office staff to ensure completion on all peer to peer review and denials. Responsible for uploading authorization numbers, status, time spans/number of procedures and supporting documentation upon verification that procedures are authorized as requested with the patients electronical medical record.Maintains a positive working relationship with the staff of the assigned clinical departments, to ensure clear communication and handeling of all patients and provider needs. Responsible for monitoring authorization request and expiring authorizations for accuracy.
COMPETENCIES AND SKILLS:
Demonstrates the ability to effectively assist with billing in regards to precertification or coding changes that need to occur for claim resolution.
Demonstrates both oral and written communication skills. Must be able to maintain confidentiality. Must be able to make responsive, sound and accurate decisions.
Demonstrates ability to be professional, resourceful, confident, and maintain a pleasant, receptive manner.
Demonstrates customer service skills and telephone etiquette.
Demonstrates ability to organize/prioritize work, ability to draw from and utilize numerous data sources, be detailed oriented and multi-task.
Demonstrates ability to perform mathematical calculations (percentages, ratios) and basic clerical skills (telephone, computer, photocopier, and fax).
Demonstrates knowledge of federal, state, third party insurances and assistance programs.
Demonstrates basic computer skills including Microsoft office required. Knowledge of automated billing systems (EPIC, IDX, SMS Passport and all other GHS applications) preferred.
Demonstrates the ability to interpret basic healthcare financial information and advise customers.
Demonstrates the ability to spell correct diagnoses, procedures, patient names.
Demonstrates excellent customer service and strong communication skills.
Demonstrates the ability to type/enter data accurately.
Must be highly motivated to improve data quality and financial position of the institution.
Demonstrates the ability to perform as a team player.
Must be able to work autonomously.
Must use critical thinking skills to determine the best financial options for patients.
EDUCATION AND/OR EXPERIENCE:
High school diploma or equivalent required.
Minimum of two years’ previous experience in Healthcare environment with focus on Registration or Financial Services required.
Previous experience in medical terminology preferred.
Previous experience with InterQual and Medicare Inpatient criteria preferred.
Previous experience with CPT and ICD-10 Coding preferred.
Previous experience with precertification and insurance verification preferred.
Overall knowledge of the revenue cycle and accounts receivable preferred.
Experience with EPIC Grand Central, Cadence and Patient Financial systems preferred.
Up to six months to learn all aspects of the job, including but not limited to; insurance verification, precertification and the demonstrated ability to effectively communicate with the appropriate providers, clinics, insurance companies and facilities as described in the Revenue Cycle Policies and Procedures.
WORKING CONDITIONS/PHYSICAL DEMANDS:
Work is typically performed in an office environment.
Ability to travel periodically to various locations as work permits.
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements and criteria considered necessary to successfully perform the job.
OUR PURPOSE & VALUES:
Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
One of the nation’s most innovative health services organizations, Geisinger serves more than 1.5 million patients in Pennsylvania and New Jersey. The system includes 13 hospital campuses, a nearly 600,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine. Geisinger is known for its focus on caring and innovative programs including the ProvenCare® best-practice approach to maximize quality, safety and value; ProvenHealth Navigator® advanced medical home; Springboard Health® population health program to improve the health of an entire community; ProvenExperience™ to provide refunds to patients unhappy with their care experience; and Geisinger’s MyCode® Community Health Initiative, the largest healthcare system-based precision health project in the world. With more than 215,000 volunteer participants enrolled, MyCode is conducting extensive research and returning medically actionable results to participants. A physician-led organization, with approximately 32,000 employees and more than 1,800 employed physicians, Geisinger leverages an estimated $12.7 billion positive annual impact on the Pennsylvania and New Jersey economies. Repeatedly recognized nationally for integration, quality and service, Geisinger has a long-standing commitment to patient care, medical education, research and community service. For more information, visit geisinger.org or connect with us on Facebook, Instagram, LinkedIn and Twitter.
** Does not qualify for J-1 waiver. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
*Domestic partner benefits not applicable at Geisinger Holy Spirit.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh Food
Farmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencing
programs, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.
Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers.
What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.