Purpose of Position:

• The purpose of this position is to reduce denials through proactive practices.

Skills and Qualifications:

• High school graduate, minimum
• Comprehensive knowledge of Patient Access process, Clinical Care process and Revenue Cycle
• Knowledge of medical terminology and managed care concepts preferred
• Experience in CPT and ICD coding preferred
• Refined communication skills, both written and oral
• Ability to cope with the stress of the position and deadlines imposed
• Refined organization skills with a well-developed style of diplomacy
• Ability to function independently, displaying personal integrity and always maintaining confidentiality
• Professional manner and appearance in accordance to the Aultman Hospital policies
• Comprehensive knowledge of computer and the software systems utilized by the clinical, registration and patient financial services departments

Primary Responsibility:

• Verify the payer source of all inpatient and OBV patients
  • Determine eligibility and benefits
• Coordinate all authorizations and pre-certifications by directly contacting payer
• Mange all outpatient prior authorization requirements for all scheduled tests or procedures
• Provide insurance related information to Case Management and Utilization Management staff

• Communicate any changes identified in the verification process to the Utilization Management staff to assure proper reimbursement
• Responsible for Patient Access related denied claims in the Denials Mgmt software system

Job Specific Requirements:

• Initiate the verification and pre-certification of insurance benefits as soon as possible post admission or pre admission when possible by electronic eligibility systems, payer website or telephone
• Convey required information to third party payers to meet requirements ensuring payment for services
• Work cooperatively with physicians offices to obtain necessary information
• Contact payers and/or phys offices to secure prior authorization for scheduled procedures
• Accurately record information in MPAC system as a method of communication with PFS to facilitate correct billing of services
• Communicate any issues of patient financial concerns to the Patient Outreach department
• Function as a team member, working closely with the Utilization Management specialist, Case Managers and Social Workers to promote positive patient outcomes
• Identify areas for inter and intradepartmental operational improvements