- Precertifies outpatient services in compliance with regulatory/insurance requirements.
- Verifies with insurance company the nature and extent of patients' insurance coverage.
- Follows-up on all claim denials for outpatient services. Determines the cause of denial, aggressively challenges wrongful denials and works with appropriate parties on resolutions.
- Assists off-site providers with procedural issues related to proper pre-certification and insurance verification requirements. Provides training to these locations as regulations/insurance requirement change and as employee turnover occurs.
- Participates with clinical, financial and utilization review departments to address opportunities to improve overall collections and cash flow.
- Responsible for automation requests that will enhance efficient collection of monies due the clinic. Able to develop format layout for programming needs.
- Analyzes data for opportunities to achieve improved collections, enhance relations with insurance companies and physician practices, and improve workflow related to outpatients.
- Perform other duties as assigned or requested.
- Collaborate with the patient, physician and other care team members as part of a team based approach to overall patient care.
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precert coord outpatient - Knoxville, TN , USA, United States - Covenant Health
Description
Outpatient Pre-Certification Coordinator, Cardiology Associates of East Tennessee
Full time, 80 hours per pay period, Day shift
Covenant Medical Group is Covenant Health's employed and managed medical practice organization, with more than 300 top Physicians and providers spanning the continuum of care in 20 cities throughout East Tennessee. Specialties include cardiology, cardiothoracic surgery, cardiovascular surgery, endocrinology, gastroenterology, general surgery, infectious disease, neurology, neurosurgery, obstetrics and gynecology, occupational medicine, orthopedic surgery, physical medicine and rehabilitation, primary care, pulmonology, reproductive medicine, rheumatology, sleep medicine and urology.
Position Summary:
Assures payment from outpatients' third party insurer by meeting all precertification requirements and by verification of patients' insurance coverage. Establishes controls so that patients understand and receive accurate information on their patient liability.
Recruiter: Bradley Sparks || ||
Minimum Education:
None specified; will accept any combination of formal education and/or prior work experience sufficient to demonstrate possession of the knowledge, skill and ability needed to perform the essential tasks of the job, typically such as would be equivalent to a high school diploma or GED. Preference may be given to individuals possessing a HS diploma or GED.
Minimum Experience:
Experience in outpatient registration, preferably in a leadership role required. Will consider LPN with two (2) years experience or individuals with inpatient pre-certification and insurance verification experience. Strong knowledge of medical terminology.
Licensure Requirement:
None.