Seasonal Denials Management Jobs (NOW HIRING)

The following information is designed to outline the functions and position requirements of this job. It does not identify all tasks that may be expected, nor address the performance standards that must be maintained.  Essential functions may change based on organizational need.

General Position Summary:

Responsible for verifying and updating patient demographics information, verifying eligibility for medical procedures with patient’s insurance company and using Summit Healthcare’s insurance verification tool for insurance authorization and verification.  Serves as a valuable resource to patients by providing excellent customer service, pertinent information regarding their coverage, and explaining coverage amounts.   Refers patients to Financial Counselor to arrange payment for services that are not covered by insurance.

Essential Functions / Major Responsibilities:

·         Provides the highest level of customer service standards.

·         Registers/pre-registers patients, gathers detailed information from the patients chart for coordination of care.

·         Verifies insurance benefits and eligibility.

·         Obtains pre-certifications and referrals to other providers and for procedures, services, or equipment.

·         Verifies/Notifies payors for procedures

·         Refers accounts to financial counselor.

·         Collects patient portions of fees when applicable.

·         Works Task List in Allscripts for all outpatients

·         Monitor stat orders and time sensitive accounts

·         Displays proper etiquette and mannerisms that reflect the SHINE Behavior Guidelines.

·         Promotes the Patient Safety Standards as a core value of the organization

In addition to Level 1 essential functions: 

·         Works reports on a daily basis:  CRC, One Content, Pre-Registration with balances, accounts not discharged, denials

·         Assists Senior Coordinator with assigned tasks

·         Provides direction guidance and training to level 1 staff

·         Attends Denials Management Committee meetings.

·         Assist with Change Health “Relay” Issue

·         Participates in departmental and hospitalwide informational meetings and inservices, including staff meetings, hospitalwide forums, and seminars.

·         Reviews department and hospitalwide policies and procedures annually.

·         Cross trains in two or more Patient Registration areas:  Outpatient, prior authorizations, ER, centralized scheduling and/or Surgery.

·         Runs and works Relay reports

·         Works Task List in Allscripts for all outpatients

·         Monitor stat orders and time sensitive accounts

Additional / Seasonal Responsibilities:

·         None.

Job Scope:

This job involves:

·         Routine work situations.

·         A mid-level of complexity.

·         Typical operation from specific and definite directions and instructions.

·         Performance under supervision.

Supervisory Responsibility:

·         None.

Interpersonal Contacts:

·         Are normally made with others both inside and outside the hospital.

·         Are made with own department as well as other departments or locations.

·         Frequently contain confidential/sensitive information necessitating discretion at all times.

·         Are made via telephone, e-mail, and face-to-face interaction.

·         Are usually with patients and staff with some physician contact.

Specific Job Skills & Mental Activities:

This position requires operational knowledge of all equipment in the Admitting areas, including: fax, printer, copy machine, phone systems, scanners, and all computer programs required to retrieve and input information. This employee must be service oriented and have excellent customer service skills, computer skills, organizational skills, multitasking skills, professional interpersonal skills, time management skills, the ability to prioritize work, and telephone etiquette. This employee must be familiar with and abide by all HIPAA rules and regulations. This employee must be able to function in a high stress area with multiple priorities and multiple sources of request, with a fast pace in decision making. This employee must also maintain a professional demeanor in traumatic situations. Must be able to read, write, speak, and understand English.

This position requires extensive amounts of time on the phone with insurance companies and ability to work within time sensitive guidelines. 

Education and/or Experience:

·         High school diploma or equivalent (required).

·         Basic computer skills (required).

·         One year related experience (preferred).

·         Medical terminology (preferred).

·         Two or more years of experience as a Patient Registrar and/or Coordinator Authorizations and Verifications I (required)

·         Cross trained in two or more Patient Registration areas (required)

·         High performer as evidenced by an evaluation score of 7.0 or higher and no disciplinary actions in the last year. (required)

·         High school diploma or equivalent (required).

·         Basic computer skills (required).

·         Medical terminology (required).

Physical Demands & Job Conditions:

Exerts up to 10 lbs. of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Involves sitting most of the time, but may involve walking or standing for brief periods of time. Worker is exposed to extensive computer work.

Physical motions include finger dexterity, standing, walking, talking, reaching, feeling, sitting, bending, grasping, listening/hearing, handling, lifting up to five pounds, and repetitive motions of the hands, wrists, and feet.

This is a safety sensitive position.

OSHA Exposure Category:

Involves no regular exposure to blood, body fluids, or tissues, and tasks that involve exposure to blood, body fluids, or tissues and are not a condition of employment.