Job Discription
JOB SUMMARY
Manages the investigation and audit process of accounts that denied due to authorization issues. LVHN Network responsibility. Researches and coordinates complete review of patient record(s) to identify opportunities for successful claim processing and payment. Identifies trends or issues and is responsible for communicating the needed correction to operational owners, modification to workflows or processes. Identifies areas for documentation and/or process improvement and promotes proactive communication to process owners.
Education – Required
Associate’s Degree or High School Diploma/GED with 3 years’ experience in insurance and authorization/precertification.
Education – Preferred
Bachelor’s Degree in a health industry discipline such as business administration, hospital administration, public administration, or related field or Specialized Diploma in Coding.
Experience – Required
1 year Denial prevention experience or 3 years Insurance and authorization/precertification experience.
Experience – Preferred
1 year knowledge of worker compensation, auto, commercial, government payer processes.
Knowledge, Skills and Abilities – Required
Knowledge of current health insurance requirements. Knowledge of insurance verification software. Strong Computer skills. Exceptional verbal and written communication skills.
Knowledge, Skills and Abilities – Preferred
Experience working with EPIC. Knowledge of Interqual criteria, utilization review, hospital department procedures.
Licenses – Preferred
Registered Nurse
Certifications – Preferred
CCS – Certified Coding Specialist
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