UnityPoint Health Behavioral Health PreAuthorization Specialist in Rock Island, Illinois
Associate is responsible for obtaining insurance eligibility, benefits, authorizations, pre-certifications and referrals for inpatient and outpatient, scheduled and non-scheduled visits for behavioral health.
Associate will also update demographic and insurance information in billing system as needed.
Will serve as the primary documentation source for access, billing and clinical staff.
Responsible for resolving accounts on work queues.
Work with insurance companies to appeal denials.
Interacts in a customer-focused and compassionate manner to ensure patients and their representatives needs are met.
Insurance verification/Certification for scheduled and non-scheduled services.
Obtains daily (in multiple) work queues to identify what is required by the Central Billing Office.
Work with providers to assure that CPT code is correct for procedure ordered is authorized when necessary.
Completes eligibility check and obtain benefits through electronic means or via phone contact with insurance carriers or other agencies.
Initiates pre-certification process with physicians, PHO sites or insurance companies and obtains pre-cert/authorization numbers and other pertinent information that secures reimbursment of account.
Performs follow-up calls as needed until verification/pre-certification process is complete.
Thoroughly documents information and actions in all appropriate computer systems.
Notifies and informs Utilization Review staff of authorization information to insure timely concurrent review.
Validates or updates insurance codes and priority for billing accuracy.
Works with insurance companies to obtain retroactive authorization when not obtained at time of service.
Works with insurance companies, providers, coders, and case managment to appeal denied claims.
Works with performance improvement in mind to identify opportunities to increase the efficiency of the work process and flow within the department.
Two years of experience in a hospital patient access/patient accounts department, medical office/clinic or insurance company required.
Knowledge of medical terminology, ICD coding and CPT codes is preferred.
Prior experience with verification, pre-certification and payer benefit and eligibility systems required.
Requires experience interacting with patients and working knowledge of third party payers and collections.
All below are and/or required;
Certificate of psychiatric rehabilitation from a DHS approved program plus a High School Diploma and 2 years of experience in providing mental health or human services.
A recovery support specialist certified and in good standing with the IL Alcohol and other Drug Abuse Professional Certification Association, plus 1 year experience providing mental health services.
Minimum of (5) years supervised experience in mental health or human services and High School Diploma.
Requisition ID: 2018-42697
Street: 2701 17th St
Name: 6020 UnityPoint Health QC Trinity
Name: Financial Clearance
FTE (Numeric Only; Ex. 0.01): 0.01
FLSA Status: Non-Exempt
Scheduled Hours/Shift: Fill in for current staff (Per diem, per required need)
External Company URL: http://www.unitypoint.org