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Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Experience: Must have a minimum of 2+ years hands-on experience in obtaining elective surgery authorizations

Specialization: Previous experience and proficiency in Orthopedics and General surgery authorizations required

Summary:

+ THE TEAM LEAD FUNCTIONS IN A SUPPORT ROLE, ASSISTING INSURANCE VERIFICATION MANAGER IN FACILITATING THE DAILY OPERATIONSOF THE DEPARTMENT, IN ADDITION TO BEING RESPONSIBLE FOR PERFORMING THE STANDARD DUTIES & RESPONSIBILITIES OF ANINSURANCE VERIFICATION ANALYST.

Responsibilities:

+ SSENTIAL JOB DUTIES AND RESPONSIBILITIES

+ 1. Support the department workflow to ensure quality standards are met by maintaining and distributing daily assignments based on incoming workloads and staff availability. Monitors WQs to make real time adjustments as necessary and act as a key backup for any gaps in staffing.

+ 2. Assists IV team with any day-to-day issues, tracks backlog and unresolved issues to report to IV Manager and acts as a clearinghouse for questions and issues, before escalating to Manager.

+ 3. Acts as a training resource for new staff and a resource for co-workers, sharing processes and workflow information.

+ 4. Assists IV Manager in monitoring verification Work Queues, days-out and registration errors.

+ 5. Generate AM and PM radiology protocol reports and initiate updates to existing precertification if warranted by clinical procedure change, by following up with physician offices and third-party payors.

+ 6. Responsible for timely transfer of next day unauthorized appointments to CSD and IR WQs for rescheduling and/or cancellation.

+ 7. Support inter-department requests by ensuring timely response to all emails sent to the IVT distribution list. Communicates with surgical, radiology and other departments as needed.

+ 8. Uses online tools, contacts insurance companies, physician offices and patients as needed to verify coverage and authorization within established guidelines. Activities include but are not limited to verifying eligibility, obtaining benefits, ensuring referrals, pre-determination and/or authorization requirements have been completed.

+ 9. Follow up with Physician offices to ensure that diagnosis codes provided meet the medical necessity criteria.

+ 10. Follows up with Penn global team for verifying appointments for patients with international insurance benefits.

+ 11. Ensures that MVA and Worker Compensation related appointments are correctly registered and verified.

+ 12. Processes correspondence from insurance companies, case management, and other departments within specified time limit.

+ 13. Determines and appropriately documents out of pocket responsibility for services as related to insurance contracts or PMPH fee schedules (i.e. Self-Pay Fee Scheduled, Cosmetic Surgery List). Provides patients with an estimate and attempts to collect payment prior to the visit.

+ 14. Follows established department protocols to communicate rescheduling/cancellation of surgeries, procedures and appointments, if authorization is not obtained prior to date of service.

+ 15. Assists IV Team and coordinates the maintenance/repair activities as related to equipment and support of business applications.

+ OTHER JOB DUTIES AND RESPONSIBILITIES

+ 1. Maintains working knowledge of Penn Medicine’s Insurance verification tools, including insurance guidelines.

+ 2. Keeps current on CPT/HCPS coding methodologies to accurately identify procedure codes needing authorization. Understands ICD-10 Coding methodologies to accurately identify diagnosis codes to support medical necessity.

+ 3. Must pass and stay current with Penn Chart certification and any other Penn Medicine Princeton Health educational requirements.

+ 4. Works in collaboration with other departmental and hospital associates supporting their efforts through teamwork and acceptance of additional assignments.

+ 5. Is able to accurately and consistently interpret and readily explain various healthcare insurance plans coverage, benefits and patient payment

+ responsibilities.

+ 6. Conforms to all applicable HIPAA, Penn Medicine, Safety and Policy guidelines.

Education or Equivalent Experience:

+ H.S. Diploma/GED (Required)

+ Education Specialization:Equivalent Experience:•And 5-8 YEARS EXPERIENCE IN A HOSPITAL AND/OR PHYSICIAN OFFICE.

+ Associate of Arts or Science

+ Education Specialization:Equivalent Experience:•And 3-5 YEARS EXPERIENCE IN A HOSPITAL AND/OR PHYSICIAN OFFICE.

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Salary Range:

$19.97 - $31.81/Hourly

As part of their job offer, successful candidates are provided a specific rate, taking into consideration various factors including experience and education.

Click here (https://www.uphshrandyou.com/public/welcome) for information on UPHS’s Benefits.

Live Your Life's Work

We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

REQNUMBER: 299597