Medical Billing Specialist
Our client in the Chadd's Ford area is seeking a candidate for their Re-Authorization and Insurance verification's team. Responsibilities include managing insurance verification's and obtaining authorization, effective collaboration with internal and external customers, and a high degree of focus on clinical expertise, including document improvement initiatives.
Essential Duties & Responsibilities
-Provides practical assistance and support to team members for complex and challenging situations related to (but not limited to) referral and document processing, insurance verification, prior authorizations, pre-determinations, coverage exceptions, out-of-network exceptions, appeals, medical necessity justification.
-Ability to comprehend and communicate complex health plan carrier benefits and medical policies to all customers (internal and external) in terms easy to understand.
-Serves as an expert and resource regarding clinical documentation, medical necessity justification and patient outcomes.
-Regularly reviews work product to identify and assess the technical knowledge of the team members; provides training (individual and group settings), effective coaching and makes use of internal and external resources to resolve gaps in knowledge, expertise, competencies and skillsets (e.g. systems, internal processes, payer guidelines, regulatory requirements, soft-skills).
-Responsible for monitoring the day-to-day work inputs and outputs; makes adjustments to meet existing and changing business demands, including but not limited to special project development and implementation.
-Adopts a continuous improvement approach and proactively reviews work processes to identify opportunities to increase efficiencies and improve effectiveness. Recommends solutions that will result in enhanced customer experiences and ability to meet corporate and departmental objectives.
Working hours: 8 AM - 5 PM
Skills, Competencies and Experience
- Self-motivated and resourceful problem solver
- Experience managing and motivating multiple employees in a high-pressure, fast-paced environment
- Ability to analyze process flows, recommend and implement changes to achieve objectives and improve outcomes
- Ability to interact with all levels of employees, including external customers, internal sales personnel and health benefits carriers
- Excellent written and verbal communication skills
- Intermediate to advanced abilities with MS Excel, Word, PowerPoint
-Experience in nutrition, including total parenteral nutrition
-Experience in renal dialysis, specialty pharmacy, home infusion
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