Lead Insurance Authorization Specialist

Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Summary:

• Position Summary: To assist Supervisor in daily operations of the Financial Clearance Center. Responsibilities include employee training, time keeping, complete reports projects, act as first line resource for staff, act as a Subject Matter Expert SME for the department, and serve as backup to the Supervisor in his her absence.

• Qualified individuals must have the ability with or without reasonable accommodation to perform the following duties: Coordinate pre-authorization process

• Serve as the primary SME for the Financial Clearance Center

• Provide training to employees on going and during NEO.

• Act as Supervisor in their stead as needed.

• Maintain a thorough knowledge of staff payor processes in order to serve any role to meet department needs.

• Provide periodic staff updates to the Supervisor.

• Verify eligibility and obtain authorization through telephonic interaction or using online insurance portals.

• Obtains necessary authorizations in a timely manner.

• Liaise with doctor's offices, hospital staff, insurance representatives, Financial Services personnel PFS , and other departments across the organization to ensure authorization and or referrals for services on file and accurate with the payer resulting in maximized reimbursement.

• Consistently identifies and resolves deficiencies with customer registration issues including but not limited to: charge inquiries, insurance inquiries, CPT code changes and patient status changes.

• Manages and resolves coverage and authorization issues from intake to final resolution.

• Analyzes and researches all escalated authorization referral issues in a professional manner.

• Maintains a thorough understanding of the revenue cycle including: insurance requirements, billing standards, and associated correspondence to be able to independently resolve issues.

• Maintains professional relationships with a wide variety of community providers.

• Interact with patients and families to obtain insurance information for newly started plans and new additions to the plan.

• Coordinates timely notification of patient arrival to insurance.

• Consistently documents appropriate information in department-designated sections of EMR regarding insurance and authorization.

• Assists Case Management for discharge planning by providing authorization information and or billing details.

• Assists Utilization Management on high priority accounts by obtaining or updating the authorization to avoid denials.

• Coordinates with Case Management and Utilization Management with issues regarding CPT code changes.

• Analyzes and researches denials to resolve denied claims with the appropriate payer and or provider office.

• Provides missing or additional information to expedite the resolution of the denied claim.

• Evaluates denied claims to determine when appeals are warranted and collaborates with the appropriate payer and or practice to resolve issue.

• Evaluates processes procedures to continuously improve job functions striving for the best outcomes for the five pillars of LEAN.

• The following duties are considered secondary to the primary duties listed above:

• Serve as back-up for time and attendance recording as needed.

• Assist with any special projects as assigned.

• Assist Supervisor with the interview process of potential employees.

• Helps foster an environment of continuous improvement by suggesting ideas to leadership.

• Participates in shadowing experiences with payer representatives, other departments and provider.

• Other duties as assigned.

Responsibilities:

• Minimum Required Qualifications:

• High school diploma or equivalent GED

• Strong written and verbal communication and organization skills.

• Excellent computer skills including Microsoft Office products.

• Ability to apply strong analytical qualities

• Demonstrates ability to be self-motivated and prioritize tasks efficiently and accurately.

• Demonstrates the ability to work as a team member.

• One 1 year of experience in a healthcare related administrative or billing setting.

• Associate's degree.

• Prior experience with authorizations.

• Attention Concentration: The following level of ability is essential for the jobholder to focus on certain aspects of current experience and reject others.

• The position requires the ability to attend to more than one aspect of a situation simultaneously. It is highly likely that multiple task demands are going to be required of the individual at the same time.

• New Learning and Memory: The following level of ability is essential for the jobholder to learn and retain material.

• A large portion of this position required reliance on verbal memory and new learning. Efficiency in processing of verbal information, either in written or spoken form, is a major requirement and prerequisite of the job. The individual must be able to attend to and process multiple bits of information simultaneously. The individual must be able to organize and categorize this information effectively so that later recall is feasible.

• Problem Solving, Reasoning and Creative Thinking: The following level of ability that is essential for the jobholder to think in order to solve a problem by combining two or more elements from past experience or imaginative thought.

• The position deals with issues or problems that often require thoughtful reasoning before arriving at approaches or solutions. Some independent thought, planning or origination of options and solutions is necessary. The individual must have the ability to apply principles of reasoning and problem solving to resolve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.

• The following are essential requirements of the position in relation to job-worker situations. These items describe how a worker must adapt, adjust, conform or act.

• Repetitive work: Ability to continuously perform the same type of work for extended periods of time, according to set procedures, sequence or pace.

Credentials:

Education or Equivalent Experience:

• Associate of Arts or Science

• H.S. Diploma/GED (Required)

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

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