Jobs at MyMichigan Health (Now Hiring) — 398 open — Page 13

Summary

Remote work considered after 90 day training period and meeting KPI requirements

 

The primary function of this position shall be to coordinate the timely completion, monitoring, and submittal of all incoming pre-authorizations for diagnostic testing procedures and surgeries. This position will work closely with providers and patients in resolving, documenting, monitoring, and communicating pre-authorizations for diagnostic testing procedures and surgeries. They will be responsible for validating preauthorization information is correct and completing appeals to insurance companies if a claim is denied related to authorization.

Responsibilities

(35%) Monitors surgical/diagnostic imaging schedules to verify that pre-authorization is in place and is correct in order to receive payment on high dollar accounts. Tracks incoming pre-authorizations using Electronic Medical Record system. Reviews referrals within Electronic Medical Record for accurate CPT codes.

(25%) Works directly with physician offices to ensure authorization for diagnostic testing procedure/surgery is in place. Provides education and training to physician offices on authorization related issues.

(20%) Provides excellent customer service to patients on the phone and face to face. Manages difficult situations that arise with authorization process.

(20%) Coordinates investigation into denials on a weekly basis and completes retro-authorization or appeal process. Responsible for ensuring appeals are submitted in a timely manner via mail, fax, telephone, or electronically.

OTHER DUTIES AND RESPONSIBILITIES

Maintains positive relations with all customers. This may include, but not limited to assisting with resolving questions, inquiries and/or issues.

Leads surgery and high dollar imaging denial management for the medical center.

 

Effectively operates a computer using MS Office applications such as Word, Excel as well as vital systems required for registration and insurance verification etc. for the department.

 

Delivers non-coverage paperwork or notification to patients or department leaders when required.

 

Knowledge of medical terminology and medical office practices, policies and procedures as normally acquired through experience working in the medical center or similar setting preferred.

 

May work directly with Operating room (OR) lead scheduler, or department, to ensure scheduled OR/procedure time is utilized for authorized services.

 

May perform pre-registration responsibilities for upcoming surgeries or procedures.

 

Other duties as assigned

Certifications and Licensures

N/A

Required Education

High school diploma or GED is required

Other Information

EXPERIENCE, TRAINING AND SKILLS:

One year medical office experience in a Medical Center or similar setting preferred.

 

Typing skills and basic computer knowledge needed to enter patient information.

 

Ability to work independently, demonstrating problem solving and organizational skills, time management skills and initiative.

 

Maintains confidentiality with all patient information and data obtained.

 

Attends appropriate meetings.

 

Ability to multi-task and work under pressure of deadlines, changes in schedules, and office routines.

 

Ability to operate all office equipment including: computer, printer, photocopier, facsimile machine, multi?line telephone, and calculator.

 

Ability to work where employee may be exposed to communicable diseases.

 

Phone, listening, and interpersonal skills needed to communicate successfully with individuals and groups and interact with people at all levels to communicate ideas and concepts in a clear and understandable manner.

 

Windows PC and Internet experience is required.

 

MyMichigan Health is a technology driven organization and employees need to demonstrate competency in Microsoft® Windows.

 

An employee may be required to participate in further learning opportunities offered by MyMichigan Health.

 

PHYSICAL/MENTAL REQUIREMENTS AND TYPICAL WORKING CONDITIONS:

Exposure to stressful situations, including those involving public contact, as well as, trauma, grief and death.

Able to wear personal protective equipment that includes latex materials or appropriate substitute if required for your position.

Is able to move freely about facility with or without an assisted device and must be able to perform the functions of the job as outlined in the job description.

Overall vision and hearing is necessary with or without assisted device(s).

Frequently required to sit/stand/walk for long periods of time. May require frequent postural changes such as stooping, kneeling or crouching.

Some exposure to blood borne pathogens and other potentially infectious material. Must follow MyMichigan Health bloodborne pathogen and TB testing as required.

Ability to handle multiple tasks, get along with others, work independently, regular and predictable attendance and ability to stay awake.

Overall dexterity is required including handling, reaching, grasping, fingering and feeling. May require repetition of these movements on a regular to frequent basis.

Physical Demand Level: Sedentary. Must be able to occasionally (0-33% of the workday) lift or carry 0-10 lbs.