Job Summary

Job Duties

• Acts as coordinator between all Revenue Cycle teams and departments, Utilization Management and Care Management, Providers, various departments, clinical departments and the patients concerning activity services which are ordered by all Geisinger providers regardless of the facility.
• Completes precertification using appropriate review criteria.
• Establish and maintain communication with all Providers, Nurses, and office staff to ensure completion on all peer to peer reviews and denials.
• Conducts research and follow-up activities on assigned accounts according to established procedures and time frames.
• Ability to understand and strive to meet targets; decrease overall Accounts Receivable over 90 days, increase Cash and effectively work through and assist patients and providers with the Discounting Policies and Bad Debt Policies.
• Submission of predetermination forms for prior approval and coordination for the patient, as appropriate.
• Assists physicians, insurance companies, employers, and others with requests concerning prior authorization to result in positive resolution.
• Coordinates efforts with other departments to resolve financial clearance, insurance, billing, collection, and other related concerns and issues.
• Completes and updates hospital account notes for all accounts reviewed.
• Works various reports to ensure all scheduled procedures were completed prior to service for all Geisinger facilities.
• Provides information to all team members and direct manager regarding insurance company updates as appropriate regarding updates, system enhancements, insurance updates, etc.
• Advises supervisor and direct manager of unusual situations, chronic financial and medical and legal problems.
• Recommends process improvement to increase efficiency in area of responsibility.
• Responsible to be available to answer patient questions pertaining to status of precertification.
• Ability to effectively assist with billing in regards to precertification or coding changes that need to occur for claim resolution.
• Responsible for timely completion of the ABN process to ensure services rendered at the time of the procedure are reimbursed.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

Position Details

Hours 8:30am - 5pm

Education

Experience