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Insurance/Denial Specialist- Full Time

4 months ago

Bowling Green, United States Wood County Hospital Full time
Job DescriptionJob Description

Wood County Hospital is currently seeking a full time Insurance/Denial Specialist. The Insurance/Denial Specialist ensures that radiation therapy services meet medical necessity and appropriateness per insurance guidelines. Initiates and coordinates pre-certifications/prior-authorizations per payer guidelines prior to services being rendered and completes the Insurance verification process. Reviews clinical information and supporting documentation for outpatient or Part B services authorization denials to determine and perform retro authorizations, reconsiderations or appeal actions to defend the revenue.
 

Shift Details:

Hours: Full time, 40 hours/week

Shift: 800am- 430pm


MAJOR TASKS, DUTIES AND RESPONSIBILITIES

  • Obtain and review treatment/therapy plan orders for medical necessity and appropriateness according insurance guidelines and requirements.
  • Obtain Patient insurance information, manage insurance pre-authorizations, edits and denials and document appropriately.
  • Responsible for tracking, obtaining, and extending authorizations from various carriers in a timely manner
  • Responsible for completing the Insurance Verification process
  • Works closely with physicians and clinic staff obtain authorizations to promote positive patient outcomes, timely treatment and positive reimbursement
  • Understands and complies with regulatory requirements by specific insurance companies.
  • Reviews, assesses and evaluates all authorization denial communications received in order to optimize reimbursement
  • This position will also cross train with the front office coordinator. Duties include scheduling, registration and patient interaction.
  • Other duties as assigned.


Qualifications:

  • Require a High School Diploma or equivalent General Education Development (GED) certificate.
  • ICD-10 and CPT-4 experience preferred
  • 1-year experience radiation oncology billing practice, pre-cert and denials preferred
  • 1-year medical office experience required.

Benefit Summary:

Join our team, and you’ll have access to a cutting-edge facility with state of the art technology. You’ll also interact with some of the region's top notch healthcare professionals. You’ll find plenty of opportunities to grow and advance your career.

We’ll also reward your hard work with:

  • Great health, dental and vision plans
  • Competitive wages
  • Prescription drug coverage
  • Flexible spending accounts
  • Life insurance w/AD&D
  • Generous short term and long term disability plans
  • Employer-matched 403(b)
  • Employer sponsored cash balance pension plan
  • Vacation and Holiday time
  • Generous tuition reimbursement
  • And a lot more

                                                                                                                                                     2406-029

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