SUBFUNCTION DEFINITION: Prepares and forwards patient claims to appropriate third-party payers. Analyzes and reviews claims to ensure that payer-specific billing requirements are met. Follows up on billing, determines and applies appropriate adjustments, answers inquiries and updates accounts as necessary.
CCHMC SALARY GRADE:6
???Pre-Authorization Utilize systems including medical records to obtain needed clinical support to efficiently confirm receipt of or to obtain pre-authorization for scheduled services and medications that require a higher level of clinical knowledge. Collaborate with internal and external resources regarding specific authorizations scenarios and manages escalated issues and provides feedback to team members. Work with team to make contact with families prior to patient scheduled visits and/or services to confirm insurance eligibility, referrals/authorizations with minimal stress to the family/patient.
???Problem Resolution Serve as second level problem resolution for both internal and external customers, involving Manager, if necessary. Responsible for research, analysis and resolution of complex issues and questions. Identify patterns in questions and problem issues with staff and participate in determining and addressing root causes.
???Collaboration Serve as a liaison between Hospital/Physicians Billing Service, Admitting, Outpatient Surgery, Outpatient Department, Patient Financial Services, Utilization Review and other Cincinnati Children's departments. Multiple division support; cross trained in order to work insurance pre-authorization for multiple divisions. Participate in Department Meetings to share payer trends related to Pre-Authorizations.
???Productivity Work independently and/or collaboratively with team to efficiently handle work volume and queues to meet or exceed productivity standards. Accurately collect/verify insurance information and demographics, obtaining insurance authorization and entering the information into the required systems. Assign tasks to the appropriate shill level as needed to ensure efficiency and productivity.
???Coordination Serve as an internal and external resource/expert for health insurance questions from customers/clients. Act as a preceptor for new employees and provide instruction for performing non-routine functions for staff. Work collaboratively with team to establish and maintain payer specific coverage libraries and communicate/update payer information health system requirements utilizing departmental SharePoint or other resources. Working knowledge and functions of multiple divisions. Complete retrospective authorizations when necessary.
??? High school diploma or equivalent ??? 3 - 5 years of work experience in a related job discipline
At Cincinnati Children’s, we come to work with one goal: to make children’s health better. We believe in a team approach, both in caring for patients and their families, and in advancing science and discovery. We strive to do better, and find energy and inspiration in our shared purpose. If you want to be the best you can be, you can do it at Cincinnati Children’s.