Prior Authorization Jobs in Delaware (NOW HIRING)

Responsible for all facets of office and hospital based surgical prior authorization management including charge entry, customer service and follow-up in accordance with practice protocol with an emphasis on maximizing patient satisfaction and profitability. Responsible for reviewing the patient demographic information in the Brandywine Urology Consultant's practice management system at the time of charge entry to ensure accuracy and to provide feedback to the other front office staff regarding patient registration. Responsible for reviewing the physician's coding at the time of charge entry to ensure accuracy, timely payments, and to maximize revenue. Responsible for providing cross coverage for the other Billing Specialists as required to ensure efficient and professional practice operations and maximum patient satisfaction.

ESSENTIAL DUTIES & RESPONSIBILITIES:

• Input all charges related to the assigned physician's professional services into the practice management system including office and hospital charges in accordance with practice protocol with an emphasis on accuracy to ensure timely reimbursement and maximum patient satisfaction. All charge batches should balance in both number of procedures and total dollar prior to posting.
• Post all payments, by line-item, received for physician's professional services into the practice management system including co-payments, insurance payments, and patient payments in accordance with practice protocol with an emphasis on accuracy to ensure maximum patient satisfaction and profitability. All payment batches must be balanced in both their dollar value of payments and adjustments prior to posting.
• Post all credit and debit adjustments to patient accounts with strict adherence to the guidelines in the Procedure Manual.
• File all charge, payment and adjustment batches in the appropriate format by batch date for quick reference.
• Review the physician's coding at charge entry to ensure compliance with Medicare guidelines and to ensure accurate and timely reimbursement.
• Provide customer service both on the telephone and in the office for all patients and authorized representatives regarding patient accounts in accordance with practice protocol. Patient calls regarding accounts receivable should be returned within 2 business days to ensure maximum patient satisfaction.
• Verify all demographic and insurance information in patient registration of the practice management system at the time of charge entry to ensure accuracy, provide feedback to other front office staff members and to ensure timely reimbursement.
• Follow-up on all outstanding insurance claims at 30,45,60 days from the date of service in accordance with practice protocol with an emphasis on maximizing patient satisfaction and practice profitability.
• Follow-up on all outstanding patient account balances at 35,60,90,120 days from the date of service in accordance with practice protocol with an emphasis on maximizing patient satisfaction and practice profitability using the A/R aged reports.
• Provide information pertaining to billing, coding, managed care networks, insurance carriers and reimbursement to physicians and managers.
• Follow-up on all returned claims, correspondence, denials, account reconciliations and rebills within five working days of receipt to achieve maximum reimbursement in a timely manner with an emphasis on patient satisfaction.
• Submit primary and secondary insurance claims electronically each day and on HCFA semi-weekly to ensure timely reimbursement.
• Attendance at relevant seminars to remain abreast of current issues regarding obstetric and/or gynecology accounts receivable, Medicare Compliance and HIPAA.
• Recommend accounts for outside collection when internal collection efforts fail in accordance with practice protocol.
• Process refunds to insurance companies and patients in accordance with practice protocol.
• Reconcile the incoming lockbox deposits in accordance with practice protocol as required to ensure timely payment posting.
• Monitor reimbursement from managed care networks and insurance carriers to ensure reimbursement consistent with contract rates.
• Proficiency with all facets of the medical practice management system including patient registration, charge entry, insurance processing, advanced collections, reports and ledger inquiry.
• Maintain information regarding coding, insurance carriers, managed care networks and credentialing in an organized easy to reference format.
• Maintain an organized, efficient and professional work environment.
• Adhere to all practice policies related to OSHA, HIPAA and Medicare Compliance.
• Other duties as assigned.

SUPERVISORY RESPONSIBILITIES:

This position has no direct supervisory responsibilities.

COMPETENCIES:

To perform the job successfully, an individual should demonstrate the following competencies:

• Technical skills. Pursues training and development opportunities; strives to continuously build knowledge and skills; shares expertise with others.
• Customer Service. Responds promptly to customer needs; solicits customer feedback to improve service, responds to requests for service and assistance, meets commitments.
• Interpersonal skills. Focuses on solving conflict, not blaming; maintains confidentiality; listens to others without interrupting; keeps emotions under control remains open to suggestion and tries new things
• Oral communications. Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; responds well to questions.
• Written communications. Writes clearly and informatively; edits work for spelling and grammar; varies writing style to meet needs; presents numerical data effectively; able to read and interpret written information.
• Teamwork. Contributes to building a positive team spirit; supports everyone's efforts to succeed.
• Quality Management. Looks for ways to improve and promote quality; demonstrates accuracy and thoroughness.
• Cost Consciousness - Works within approved budget; develops and implements cost saving measures; contributes to profits and revenue; conserves organizational resources.
• Diversity - demonstrates knowledge of EEO policy; shows respect and sensitivity for cultural differences; educates others on the value of diversity; promotes harassment free environment; builds a diverse work force.
• Ethics. Treats people with respect; keeps commitments; inspires the trust of others; works with integrity and ethically.
• Judgment. Displays willingness to make decisions; exhibits sound and accurate judgment; support and explains reasoning for decision; includes appropriate people in decision-making process; makes timely decisions in scope of their duties
• Motivation. Sets and achieves challenging goals; demonstrates persistence and overcomes obstacles.
• Professionalism. Approaches others in a tactful manner; reacts well under pressure; treats others with respect and consideration regardless of their status or position; accepts responsibility for own actions; follows through on commitments.
• Quality. Demonstrates accuracy and thoroughness; looks for ways to improve and promote quality.
• Quantity. Completes work in timely manner; works quickly.
• Safety and Security - Observes safety and security procedures; determines appropriate action beyond guidelines; reports potentially unsafe conditions; uses equipment and materials properly
• Adaptability. Adapts to changes in the work environment; manages competing demands; changes approach or method to best fit the situation; able to deal with frequent change, delays or unexpected events.
• Attendance/punctuality. Is consistently at work and on time; ensures work responsibilities are covered when absent.
• Dependability. Follows instructions, responds to management direction; takes responsibility for own actions; keeps commitments, commits to long hours of work when necessary to reach goals.
• Initiative. Volunteers readily; asks for and offers help when needed.
• Innovation. Displays original thinking and creativity; meets challenges with resourcefulness; generates suggestions for improving work; develops innovative approaches and ideas; presents ideas and information in a manner that gets others' attention.

QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily and independently. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION AND EXPERIENCE:

Requires a minimum of 3 years of accounts receivable experience, preferably in a surgical subspeciality private practice setting.

LANGUAGE SKILLS:

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers, employees, and/or physicians.

MATHEMATICAL SKILLS:

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.

REASONING ABILITY:

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.

COMPUTER SKILLS:

To perform this job successfully, an individual should have knowledge of and experience on a computer in a Windows environment. Experience with but not limited to spreadsheet software, word processing software and electronic medical record systems is necessary.

CERTIFICATES, LICENSES, REGISTRATIONS:

• N/A

OTHER QUALIFICATIONS:

• Ability to handle patients in a pleasant, efficient and professional manner
• Helpful to have knowledge of medical processes, procedures, lab and radiology tests and medications
• Suggested background in medical terminology and general office procedures

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is required to sit, stand, and continuously use a computer keyboard and mouse.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.