Obtains and manages any required documentation (as required by state or other regulatory entities for designated testing) to determine preauthorization, informed consent requirements and other requirements from a variety of insurance plans, payers and governing sources. Handles all payer, physician and patient contact. Troubleshoots both complex medical/technical compliance and routine requests. Partner with Health Plans team to drive resolution on challenges with regards to pre-authorization and denials.
• Ability to perform all tasks of a Special Testing Services Coordinator.
• Handles client, sales, and patient inquiries regarding preauthorization and billing.
• Responds to patient complaints and assures appropriate action for resolution occurs. Handle sensitive and escalated client and patient interactions.
• Assists in documenting standard operating procedures for the Department.
• Provides input and guidance to staff members in order to ensure continuous improvement in processes which will improve customer service.
• Works with Compliance to report and resolve any billing compliance concerns.
• Supports billing teams by providing guidance with regards to facilitating appeals in order to maximize reimbursement experience. Provides training to billing teams on pre-authorization systems.
• Researches denial concerns and reports to management and billing teams in order to foster a bridge between pre-authorization and billing. Identifies and escalates reimbursement and denials issues and potential resolution techniques to management and billing teams.
• Coordinates testing in parallel to obtaining proper documentation to comply with all payer requirements.
• Documents reporting or call history in the patient file and maintains appropriate records. Also documents tools for pre-authorization team and billing teams in the form of job aids and databases which warehouse payer and process information.
• Support Health Plans team by articulating where their support is necessary, in order to drive improvements in pre-authorization process or reducing denials and write offs.
• Recognizes quality service issues and provide feedback to appropriate personnel on opportunities for improvement.
• Has ongoing responsibility for maximizing department quality and productivity by monitoring service levels and minimizing abandoned calls by supporting the phone queue.
• Other duties as required of the designated "senior" in the department.
• Bachelor's degree preferred, related work experience considered in lieu of a degree.
• Medical billing experience preferred; understanding of medical terminology required.
Comfort around higher management (lab manages, medical professionals, health plan agents)Problem SolvingCustomer FocusPriority SettingPerseveranceAction oriented Informing
Posted 32 minutes ago
Posted 31 minutes ago
Bluffton, South Carolina
Posted 31 minutes ago