||POSITION SUMMARY: The Financial Review Specialist is responsible for coordinating the day-to-day operations of insurance verification, PCP referrals, medical necessity screening and prior authorizations for specialized outpatient infused drugs, procedures and imaging. Responsible for understanding the complexities of commercial and government-funded health plan requirements. These include variations in coverage guidelines and payer documentation required to request and appeal submissions. Duties to include, but not limited to: Assists pharmacists and patient advocates with urgent and/or complex pre-certification needs. Acts as a liaison between staff, Financial Counselor, Scheduling and Check-In to ensure coverage of all services. Responsible for educating staff on new and existing insurance verification software. This includes securing access, instructing on documentation standards and QA post-implementation. Conducts periodic quality audits of routine transactions in a quantitative format. Orients new insurance verification employees using a skills assessment tool and advises manager of progress. Assists Manager and the Revenue Cycle Team with process improvement. Covers insurance verification, PCP referral, medical necessity screening and prior authorization functions as neededMINIMUM EDUCATION REQUIRED: Associates degree with additional work experience or education in the healthcare field. Must obtain Certified Health Access Associate (CHAA) certificate within one year of hire.PREFERED EDUCATION: Familiarity with coding a plus. Certified Professional Coder with AAPC within 18 months.MINIMUM EXPERIENCE REQUIRED: Three (3) years in a medical office setting; One (1) year work experience with registration, patient accounts services or processing referrals/prior authorizations. OTHER SKILLS REQUIRED: Ability to prioritize and problem-solve in a face-paced team environment. Verbal and written aptitude for diplomatic communication with the providers, pharmacists, Financial Counselors and schedulers as well as external customers such outside providers and RNs who review authorizations for payors. Must demonstrate the ability to work well with others and to work independently without direct supervision. Must exhibit a caring attitude toward patients, co-workers, and other customers. Ability to handle multiple priorities successfully. Position requires close attention to detail. Must present in a professional manner. Typing skills of 40 wpm with a general working knowledge of Word, Excel and Microsoft Office. WORKING ENVIRONMENT: Seated for long periods of time; standing, walking; considerable amount time viewing multiple simultaneous screens on computer; work in a pleasant but fast-paced office environment. High noise level due to multiple phones and conversations.
Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.