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Employment Type:

Full time

Shift:

Day Shift

Description:

Responsible for all aspects of the authorization/pre-certification, referral process and identifies

amendments/retros to help maximize revenue for departments when CPT (Current Procedural

Technology) codes for technologies and services change. Assists in maintaining charge review

and claim edit registration work queues and identifying trends to optimize workflows/education

needed.

This is NOT a remote position.

ESSENTIAL FUNCTIONS 1. Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions. Contacts insurance companies via appropriate methods and obtains pre-certifications and authorizations.

2. Obtains urgent authorizations same day, next day.

3. Verifies correct procedural and diagnostic codes and insurance verification.

4. Monitors in basket, email, and fax server if applicable. Follows up on correspondence timely and accurately.

5. Monitors authorizations or denials and follows up, as necessary.

6. Generates authorization information for physicians, patients, and health plans.

7. Obtains pre-certifications, insurance, and testing authorizations for medical procedures.

8. Communicates denials to appropriate staff and next steps.

9. Acts as a liaison among providers, staff, health plan administrators and hospital representatives.

10. Relays clinical information to health plan case managers for special procedure precertification and out-of-plan or out-of-network referrals; monitors authorizations or denials and follows up, as necessary.

11. Communicates referral status to staff and physicians; ensures that authorizations have been processed accurately and in a timely manner to coincide with patient treatment plan.

12. Assists offices in resolving billing discrepancies and any other referral/authorization issues.

13. Participates in revenue targeted projects and addresses opportunities and barriers as they arise.

14. Answers incoming calls.

15. Supports other offices, attends required meetings and training, performs research, e-learning to stay current on best practices and participates in committees as requested.

16. Handles amendments and retro-authorizations to recoup revenue.

17. Handles retro-authorizations in the retro-authorization work queue.

18. Identifies opportunities to prevent denials future state.

19. Responsible for PB REG Newborn Review work queue.

20. Resolves issues in the Hospital PB REG Charge Review and Claim Edit work queues.

21. Assists with special projects and assumes additional duties as assigned. Scans and files documents.

22. Ability to work remotely from home following Trinity remote work guidelines.

23. Maintains a working knowledge of applicable Federal, State, and local laws/regulations, the Trinity Health’s Integrity and Compliance Program and Code of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran