Job Summary

Obtain and secure prior authorization for high end procedures,hospital scheduled admissions and/or specialty patients. Verifies and completes insurance verification on such studies to ensure patient has coverage prior to appointment date. Establish and maintain communication with all necessary providers, nurses, and office staff to ensure completion on all peer to peer review and denials. Acts as a liaison for all financial matters to insurance companies, departments and patients.

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

Internet requirements:

​Employee required to have/supply: Cable modem, (high speed, only - No DSL or Wireless Cellular Service or Satellite Service) The minimum requirement is:

• •25 MBPS UP
• •75 MBPS DOWN
• •<150 ms Ping Required
• •<30ms Jitter Required

Computer must be connected to the internet via Ethernet cable; wifi is not permitted unless a Virtual Private Network (VPN) is used for the wifi connection

Education

High School Diploma or Equivalent (GED)- (Required)

Experience

Minimum of 2 years-Related work experience (Required)

Skills

Mathematics; Teamwork; Communication; Regulatory Environment - Financial Services; Organizing

About Geisinger

Founded more than 100 years ago by Abigail Geisinger, the system now includes ten hospital campuses, a 550,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine. With nearly 24,000 employees and more than 1,700 employed physicians, Geisinger boosts its hometown economies in Pennsylvania by billions of dollars annually. Learn more at geisinger.org or connect with us on Facebook, Instagram, LinkedIn and Twitter.

Our Commitment to Diversity, Equity and Inclusion

Geisinger values who you are, where you are from, and where you are going. We seek out people of various backgrounds and cultures with unique abilities, non-traditional career paths and ambitious aspirations. We are an Affirmative Action, Equal Opportunity Employer. Women and Minorities are encouraged to apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status. Read more about Our Commitment to Inclusive Recruiting.

Our Vision & Values

Everything we do is about making better health easier for our patients, our members, our students, our Geisinger family and our communities.

KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.

EXCELLENCE: We treasure colleagues who humbly strive for excellence.

LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.

INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.

SAFETY: We provide a safe environment for our patients and members and the Geisinger family.

Our Benefits

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and prescription coverage.