Work Schedule/Days: Day / Monday – Friday
Employment Type: Full-Time
Location: Support I
Requisition #: 82529
Serves as expert/lead team member while participating in authorization and pre-certification of healthcare services to prevent claims denial and/or appointment cancellation/rescheduling due to authorization issues (e.g., ensuring referring physician obtains prior authorization from insurance company for all scheduled healthcare procedures within assigned department/area). Provides ongoing communication and training to physician offices, patients/families, and others to resolve authorization-related departmental issues. Proactively identifies and communicates with families the financial resources available to patients whose health plan does not include coverage for services and coordinates counseling services with Financial Counseling as required. Collaborates with Appeals department to overturn claims denied. Initiates and performs revenue cycle activities required for insurance verification, authorization, and pre-registration. Works collaboratively with team members to provide quality service. Proactively supports efforts that ensure delivery of safe patient care and services and promote a safe environment at Children’s Healthcare of Atlanta.
- High school diploma or equivalent
- No professional certifications required
- 3 years of experience in healthcare
- Bachelor’s degree
- 3 years of experience in a hospital facility, handling insurance verification
- Successful completion of a medical terminology course
- Certified Patient Account Representative (CPAR) or Certified Healthcare Access Associate (CHAA)
- Experience in a pediatric hospital
KNOWLEDGE SKILLS & ABILITIES*
- Demonstrated multitask and problem-solving skills
- Ability to work independently in a changing environment and handle stressful situations
- Excellent verbal and written communication skills
- Demonstrated arithmetic and word mathematical problem-solving skills
- Must be able to successfully pass the Basic Windows Skill Assessment at 80% or higher rating
- May require travel within Metro Atlanta as needed
- Demonstrated working knowledge of ICD-9 and CPT codes
- Must be able to speak and write in a clear and concise manner in to convey messages and ensure the customer understands whether clinical or non-clinical
- Proficient in Microsoft Word/Excel/Outlook, SMS, Epic, CSC Papers, scheduling systems (e.g., NueMD, RIS, SIS), IMS Web, Report Web, and insurance websites (e.g., BCBS, RADMD, WebMD, Wellcare, Amerigroup, UHC)
- Ensures revenue cycle activities are completed daily, including verification and authorization of healthcare services to prevent claims denials and appointment cancellation/rescheduling.
- Performs daily quality audits to ensure all healthcare services are authorized and documented accurately and timely.
- Acts as resource for employees to handle/resolve difficult authorization issues or answer questions.
- Works to ensure referring physician obtains prior authorization from insurance company for all scheduled healthcare procedures within assigned department/area.
- Contacts referring physicians and/or patients to discuss rescheduling of procedures due to incomplete/partial authorizations, review prep instructions, or provide/obtain other information.
- May reschedule procedures in consideration of appointments cancelled due to insurance authorization issues, utilizing cancellation waitlist to optimize departmental efficiencies.
- Monitors insurance authorization issues to identify trends and participates in process improvement initiatives, including generating reports or monitoring work queues to review denials or other key performance indicators.
- Acts as liaison between clinical staff, patients, referring physician’s office, and insurance by informing patients and families of procedures authorization delays/denials, answering questions, offering assistance, and relaying messages pertaining to authorization of procedure/service.
- Performs revenue cycle activities required for pre-registration and registration, facilitating insurance pre-certification and authorization.
- Acts as resource in pre-screening physician’s orders to ensure completeness/appropriateness of scheduled appointment.
- Collaborates with Appeals department to provide all related information to overturn claims denial.
- Provides ongoing communication and training to employees, physician offices, patients/families, and others as necessary to resolve insurance authorization issues.
- Orients new employees to the department and acts as resource for staff to resolve/handle difficult situations or answer questions.
- May conduct performance evaluation of staff, provide input into hiring and disciplinary actions, and may act as supervisor as required or upon absence of supervisor.
- May answer telephone, greet patients and visitors, and proactively assist with waiting room management and tidiness.
- Assist Supervisor and/or Manager with development of staff by: being available to teammates, acting as a resource to help complete complicated/complex tasks, providing on the job training to team, and seeking out opportunities to become actively involved in staff workflow and development.
- Provide Supervisor and/or Manager feedback on staff performance, educational needs, and workflow status.
Safety: Practices proper safety techniques in accordance with hospital and departmental policies and procedures. Responsible for the reporting of employee/patient/visitor injuries or accidents, or other safety issues to the supervisor and in the occurrence notification system.
Compliance: Monitors and ensures compliance with all regulatory requirements, organizational standards, and policies and procedures related to area of responsibility. Identifies potential risk areas within area of responsibility and supports problem resolution process. Maintains records of compliance activities and reports compliance activities to the Compliance Office.
The above statements are intended to describe the general nature and level of work performed by people assigned to this classification. They are not intended to be an exhaustive list of all job duties performed by the personnel so classified.
Ability to lift up to 15 lbs independently not to exceed 50 lbs without assistance
Bending/Stooping – Occasionally (activity or condition exists up to 1/3 of time)
Climbing – Occasionally (activity or condition exists up to 1/3 of time)
Hearing/Speaking – Effective communication with employees, supervisors/managers and staff. Effective communications with patients and visitors, as required.
Lifting – Occasionally (activity or condition exists up to 1/3 of time)
Pushing/Pulling – Occasionally (activity or condition exists up to 1/3 of time)
Sitting – Frequently (activity or condition exists from 1/3 to 2/3 of time)
Standing – Occasionally (activity or condition exists up to 1/3 of time)
Walking – Occasionally (activity or condition exists up to 1/3 of time)
Some potential for exposure to blood and body fluids
Address: 1575 Northeast Expressway, Bldg 1, Atlanta, GA 30329
Function: Revenue Cycle – Patient Access