Description
Job Summary:
Coordinates all the functions and activities related to patient pre-certification/authorization including, but not limited to accurate and complete patient registration in the approved organization electronic scheduling and billing systems and on-site insurance verification.
Join one of the largest healthcare systems in the Baltimore-Washington metro region, also recognized as one of the "Healthiest Maryland Businesses". Apply today and learn how MedStar Health can be your next great career move!
Primary Duties:
Contributes to the achievement of established department goals and objectives and adheres to entity, hospital and/or department policies, procedures, quality standards, and safety standards. Complies with governmental and accreditation regulations.
Referrals/Authorizations: Verifies eligibility and conformance to the department and departmental managed care requirements and contracts. References the MedStar Managed Care Matrix and online Handbook as necessary. Obtains insurance referrals and pre-authorizations. Submits all referral information to necessary providers, as appropriate; Assists with pre-authorizations of hospital admissions, procedures, medications and medical equipment.
Maintains ongoing communication with insurance companies to determine eligibility of benefits, deductible status, and to obtain precertification for office-based and other procedures. Educates and informs patients and families regarding verification status and issues related to deductibles, co-payments and balances; Responds to hospital staff and/or patient inquiries regarding referrals, authorizations, and scheduling in an efficient manner.
Registration: Searches the Enterprise Access Directory (EAD) to establish if the patient is new or existing. Follows guidelines to avoid duplicate medical record assignment; Obtains and/or verifies complete demographic and insurance information from the patient. Accurately enters complete demographics, insurance information and Financial Status Classification (FSC) / Hospital Patient Accounting Plan Code assignment into the approved organization's electronic scheduling and billing systems.
Pre-certification/Authorization & Billing: Responsible for resolving all outstanding Alerts on pending appointments within 48 hours of the scheduled appointment, to minimally include: Missing Referral, Missing Pre-certification/Authorization, Self Pay Accounts, Eligibility Verification, Missing Demographic/Insurance Information, MedStar and/or department specific requirements, and Entering all relevant data, linking to the appropriate appointment/visit and ensures all required data elements are captured.
Qualifications:
Associate degree required, or Consideration will be given to an appropriate combination of education/training and experience (1 year of relevant education may be substituted for 1 year of required work experience)
3-4 years' experience in a medical/clinical office with working knowledge of IDX/GE Centricity business is preferred
Previous experience with computerized scheduling and registration systems required
Previous experience with an electronic health record system desire, especially GE centricity clinical or Aria required
Why MedStar Health?
At MedStar Health, we understand that our ability to treat others well begins with how we treat each other. We work hard to foster an inclusive and positive environment where our associates feel valued, connected, and empowered. We live up to this promise through:
- Strong emphasis on teamwork - our associates feel connected to each other and our mission as an organization. In return, our effective team environment generates positive patient outcomes and high associate satisfaction ratings that exceed the national benchmark.
- Strategic focus on equity, inclusion, & diversity - we are committed to equity for all people and communities. We continue to build a diverse and inclusive workplace where people feel a sense of belonging and the ability to contribute to equitable care delivery and improved community health outcomes at all levels of the organization.
- Comprehensive total rewards package - including competitive pay, generous paid time off, great health and wellness benefits, retirement savings, education assistance, and so much more.
- More career opportunities closer to home - as the largest healthcare provider in the Baltimore-Washington, D.C. region, there are countless opportunities to grow your career and fulfill your aspirations.
About MedStar Health
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation, and research. Our team of 32,000 includes physicians, nurses, residents, fellows, and many other clinical and non-clinical associates working in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest home health provider in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar Health is dedicated not only to teaching the next generation of doctors, but also to the continuing education, professional development, and personal fulfillment of our whole team. Together, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. It's how we treat people.
MedStar Health is an Equal Opportunity (EO) Employer and assures equal opportunity for all applicants and employees. We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations. MedStar Health makes all decisions regarding employment, including for example, hiring, transfer, promotion, compensation, benefit eligibility, discipline, and discharge without regard to any protected status, including race, color, creed, religion, national origin, citizenship status, sex, age, disability, veteran status, marital status, sexual orientation, gender identity or expression, political affiliations, or any other characteristic protected by federal, state or local EO laws. If you receive an offer of employment, it is MedStar Health's policy to hire its employees on an at-will basis, which means you or MedStar Health may terminate this relationship at any time, for any reason.
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