| Primary City/State: Mesa, Arizona Department Name: Denial Recovery-Corp Work Shift: Day Job Category: Revenue Cycle A rewarding career that fits your life. Those who have joined the Banner mission come from all walks of life, united by the common goal: Make health care easier, so life can be better. If changing health care for the better sounds like something you want to be part of, apply today. This position is a great learning experience of what goes on behind the scenes to ensure reimbursement for patients being admitted. You will be a part of the action without being at the hospital. This position works from home and collaborates with payors, facility admitting staff, utilization review and nurses. This role is responsible for the administrative tasks for our patients who have been admitted in our facilities which includes: sending clinicals, entering authorizations, entering concurrent denials for the Concurrent RNs, working lack of information and coordination of benefits denials. The goal is to prevent post-billing denials. It is very task oriented in completing clinical requests timely to prevent denials. This position requires someone to be adaptable to change as the workload depends on volume which varies by season. Your pay and benefits are important components of your journey at Banner Health. Banner Health offers a variety of benefits to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life. Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care. POSITION SUMMARY
This position assists in the administration of Utilization Management functions to include organization of workflow, communications with the system, critical information tracking and links with external payor representatives. This position is focused on supporting the role of utilization management process to protect the organization's financial goals. This position works closely with utilization review staff, insurance companies, patient financial services and central billing office.
CORE FUNCTIONS
1. Handles incoming requests for patient medical records, notifications of authorizations and denials and other related communications. Receives and verifies requests and external communications, initiates insurance verification, gathers and submits all information necessary for certifications for medical necessity. Provides on-going follow-up of requests, up to and following patient discharge.
2. Builds clinical response to external requests using information in patient medical record to provide minimum data necessary to coordinate authorizations. Follow up communication with insurance companies with information as required and documents responses for follow up as identified.
3. Performs data entry of patient intake information into computer system. Records insurance information and authorization requirements and notes information in the identified data entry systems.
4. Facilitates problem solving with hospitals, providers, referral sources, insurance companies, and clinical staff. Assists in the maintenance and communication of changing payor and referral source information specific to coordination of patient needs.
5. Ensures communications between payor and hospital occurs per payor request. This includes accurate transcription and routing of third party payor communications.
6. Abstracts information from patient medical records pertaining to patient identification, treatments, procedures and outcome as required by duties assigned. Documents accurately and timely in electronic record of insurance review activities and notifications of authorizations and denials.
7. Participates in departmental improvements, Banner initiatives and performs data collection for measurement of projects.
8. Works collaboratively with team members; promotes collaborative relationships with commercial payors and external customers.
9. Works under general supervision. Confers with supervisor on any unusual situations. Positions are corporate or InTouch based with no budgetary responsibility. Internal customers: All levels of nursing management and staff, medical staff, and all other members of the interdisciplinary health care team. External Customers: Insurance providers, county and governmental agencies and any reimbursement related entities. Non-clinical staff are not responsible for conducting any UM review activities that require interpretation of clinical information. Licensed health professionals are available and indicate process for the oversight. For initial screening, the organization limits use of non-clinical administrative staff to the following; Performance of review of service request for completeness of information, Collection and transfer of non-clinical data, Acquisition of structured clinical data, Activities that do not require evaluation or interpretation of clinical information. The organization ensures that licensed health professionals are available to non-clinical administrative staff while performing initial screening.
Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.
NOTE: The core functions are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Specific tasks or responsibilities will be documented as outlined by the incumbent's immediate manager.
MINIMUM QUALIFICATIONS
High school diploma/GED or equivalent working knowledge.
The position requires a proficiency level typically achieved with 3 years experience in healthcare as a Nursing Asst, Medical Asst, Health Unit Coordinator, Patient Care Tech, etc.
Requires an understanding of medical terminology. Must demonstrate effective communication skills, human relations skills, strong organizational and time management skills and flexibility in responding to multiple demands.
PREFERRED QUALIFICATIONS
Bilingual, preferred in some assignments.
Additional related education and/or experience preferred. |
