About this role
JOB DUTIES
Reviews accounts as well as communicates with insurance companies to get appeal determinations.
Responds to telephone calls and messages from patients, insurance companies and staff courteously and promptly with an emphasis on effective resolution.
Reviews accounts to see if payment has been received and keep documentation log
Create and maintain department spreadsheets
Demonstrates knowledge of organizational policies regarding insurance appeals
Generates special reports as needed.
Assist Director of Utilization Management by creating meeting invites, PowerPoints, and work orders as needed. Will also assist Director with different case issues that come up throughout the day
Verify surgical pre-authorizations for elective surgery cases
Notify insurances of discharges
Assist with general cleanliness of department
Upload all faxes, letters and appeal letters to the account in care manager.
Demonstrates knowledge of various insurance programs regarding covered and non-covered services.
Notifies administrative personnel of important situations or problems.
Prepares monthly departmental reports
Ensures compliance in all regulatory areas.
Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
Work with Denials staff and assist as needed
Order supplies for the office as needed
Answers office mainline phone and directs calls as needed
Takes care of sorting all faxes and communications received via mail etc and distributing to staff in timely manner
Responsible for assisting with MOON distributions to observation patients and certified mailings
Performs other duties as assigned.