Position Summary: Assist in coordinating the pre-authorization and assistance programs. Provides timely communication to the providers and nursing staff and patients as it relates to insurance guidelines and pre-authorization process. Assists in assessment of patient financial needs. Provides information regarding available patient assistance programs. Assists in the claims denial process for insurance carriers and develops an appropriate appeals response as necessary.Minimum Qualifications:Required
High School diploma
Preferred
1 year in a hospital or outpatient clinic setting
Previous ICD-10 and CPT coding
Previous experience in medical pre-authorization, case management and / or financial counseling
Essential Job Functions:In addition to the essential functions of the job listed below, employees must have on-time completion of all required education as assigned per DNV requirements, Bozeman Health policy, and other registry requirements.
Verifies eligibility and benefit information with insurance companies and communicates with physicians and staff before services are scheduled.
Collaborates with staff and referring clinics regarding pre-authorizations.
Collaborates with staff regarding denials.
Reviews patient assistant program guidelines for potential patient enrollment.
Communicates and collaborates with Clinical Operations Manager.
Knowledge, Skills, and Abilities
Demonstrates sound judgement, patience, and maintains a professional demeanor at all times
Strong interpersonal, verbal and written communication skills
Creativity, problem analysis and decision making
Ability to work varied shifts
Exercises tact, discretion, sensitivity and maintains confidentiality
Computer applications, MS Office, EMR, internet applications and standard office equipment
Ability to analyze, organize and prioritize work while meeting multiple deadlines
Self-directed, completes assignments accurately, thoroughly and with minimal oversight
Strong emotional intelligence, interpersonal and teamwork skills
Physical Requirements
Lifting, Pushing, and Pulling: Lift 30 pounds of weight (pick up supplies, move equipment, etc.) Carry equipment/supplies.
Extended Hours: The role may involve working for extended periods, requiring sitting, walking, or standing for eight or more hours daily.
Flexible Schedule: The position may necessitate working beyond a standard 40-hour workweek, including weekends and after-hours shifts
On-Call Availability: On-call work may be required to respond promptly to organizational, patient, or employee needs
Effective Communication: Proficient in effective communication, both in person and through various technologies
Handling Challenging Situations: The role may involve dealing with upset individuals, requiring the ability to de-escalate situations and work effectively with frustrated patients, families, or employees
Repetitive Tasks: Ability to perform repetitive tasks as needed to fulfill job responsibilities
ExposuresTasks Include Potential Exposure: Job tasks may involve exposure to:
Bloodborne pathogens, such as blood, bodily fluids, or tissues.
Radiation in settings where medical imaging procedures are performed
Various chemicals and medications used in healthcare settings. Job tasks may involve handling cleaning products, disinfectants, and other substances.
Infectious diseases due to contact with patients in areas that may have contagious illnesses
The above statements are intended to describe the general nature and level of work being performed by people assigned to the job classification. They are not to be construed as a contract of any type nor an exhaustive list of all job duties performed by individuals so classified.
77212050 Patient Access Management
