Job Closed
This listing is no longer active.
Authorization & Clearance Specialist; Days; Remote
Location
United States
Posted
53 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Authorization & Clearance Specialist; Days; Remote
Jackson Health
***** Experience in Health Insurance, Surgical cases and CPT codes Shift; Days Location: Remote Miami, FL Full-Time Financial Clearance Center (FCC) Summary Authorization & Clearance Specialist plays a critical role in ensuring that medical services provided to patients are covered by the patient's insurance providers. They are responsible for obtaining pre-authorizations, initiating authorizations, extending concurrent authorization, verifying insurance coverage for medical procedures, treatments, hospital stays, initiating retroactive authorization modifications, and discharge notifications as appropriate. Responsibilities Identifies and confirms valid coverage for an episode of care and/or specific service: contacts insurance companies and/or reviews electronic response summary and coverage discovery information to ensure the appropriate coverage coordination are on the patient's record. Initiates authorization with patient insurance by submitting necessary clinical documentation, continues to follow up, obtain and validate authorization/referrals/notifications with appropriate CPT, ICD-10 codes, Tax ID and NPI #s within the appropriate timelines. Works daily work queues according to department directives, to identify patients requiring authorization for services scheduled and non-scheduled appropriately prioritizing work assignments based on scheduled appointment date/time, medical severity, payer assignments, dollar value etc. Verifies that the services the patient is set to receive is a covered benefit, validates benefit package restrictions, and completes quality assurance checks on authorization patient type, facility, etc. Understands patient deductibles, out of network referrals, out of pocket limitations, and lifetime/event caps on liability. Refers patients to appropriate Financial Counselor, Prior Authorization or Billing based on financial coverage, financial situation, employment status, liability and/or patient concern. Uses insurance discovery tools available to attempt to validate any and all insurance coverage, ensure correct insurance coordination of benefits are listed on patient's record, follows up with patient/next of kin/Social Work/Case Management in order to obtain insurance coverage information. Verify all insurance and obtain pre-certification/authorization for services, as warranted, and notifying patient and referring physician in the event of failed eligibility and/or authorization. Follows up with and escalates as appropriate to physician's office/clinical teams/Case Management for any pending clinical documentation, including peer-to-peer requests. Diligently follows up on any pending authorizations to ensure information is processed with the insurance payer within appropriate timelines. Works directly with JHS medical services to ensure procedures, diagnoses, level of care, are sufficient for each case by following CMS and payer guidelines and communicating with medical team for corrections. Maintain knowledge base of all programs offered by JHS for Charity and Financial Assistance and the requirements to qualify, with the process for Charity Care clearance of scheduled procedures and coverage. Calculates patients' financial responsibility based on patient benefits using the estimator tools and includes communication with the patients on the out of pocket due at service. Coordinate Self-pay Package pricing by utilizing tools available and escalating to Managed Care team to obtain appropriate package price amounts not found on list or complex contracts. Receives and processes all patient payments in accordance with JHS Collections Policy and Procedure, issues receipt and maintains the integrity of all payments. Scans/uploads all required documents into the appropriate folder in the documenting imagining system in a timely manner to assure maximum reimbursement and compliance. Assist in supporting go lives of new systems and different department initiatives, including onboarding and training team members. Cross-trained in multiple areas/service lines/payers to substitute all staff positions as needed. Demonstrates behaviors of service excellence and CARE values (Compassion, Accountability, Respect and Expertise). Performs other related job duties as assigned. Experience Generally requires 0 to 3 years of related experience. Financial clearance experience is strongly preferred. Education High school diploma is required. Bachelor's degree in related field is strongly preferred. Skill Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines. Ability to communicate effectively in both oral and written form. Ability to handle difficult and stressful situations with critical thinking and professional composure. Ability to understand and follow instructions. Ability to exercise sound and independent judgment. Knowledge and skill in use of job appropriate technology and software applications. Credentials Valid license or certification is required as needed, based on the job or specialty. Unit Specific Credential Working Conditions Physical Requirements - Job function is sedentary in nature and requires sitting for extended periods of time. Function may require frequent standing or walking. Must be able to lift or carry objects weighing up to 20 pounds. Jobs in this group are required to have close visual acuity to perform activities such as: extended use of computers, preparing and analyzing data and analytics, and other components of a typical office environment. Additional information and provision requests for reasonable accommodation will be provided by the home unit/department in collaboration with the Reasonable Accommodations Committee (RAC). Environmental Conditions - Jobs in this group are required to function in a fast paced environment with occasional high pressure or emergent and stressful situations. Frequent interaction with a diverse population including team members, providers, patients, insurance companies and other members of the public. Function is subject to inside environmental conditions, with occasional outdoor exposures. Possible exposure to various environments such as: communicable diseases, toxic substances, medicinal preparations and other conditions common to a hospital and medical office environment. May wear Personal Protective Equipment (PPE) such as gloves or a mask when exposed to hospital environment outside of office. Reasonable accommodations can be made to enable people with disabilities to perform the described essential functions. Additional information and provision requests for reasonable accommodation will be provided by the home unit/department in collaboration with the Reasonable Accommodations Committee (RAC).
Related Guides
Related Categories
Related Job Pages
More Billing Specialist Jobs
Senior Health Equity Specialist
Centene CorporationTransforming the health of the communities we serve, one person at a time.
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT **The ideal candidate will reside within the state of WA.** Position Purpose: The Senior Health Equity Specialist is responsible for maintaining compliance with regulations and contractual obligations pertaining to Culturally and Linguistically Appropriate Services (CLAS) and Health Equity within State Health Programs, Commercial and Medicare product lines. The Senior Health Equity Specialist ensures that culturally and linguistically appropriate services are provided to members, including identifying and implementing health equity initiatives, representing the health plan on national, regional and multi-plan initiatives and assessing operations for gaps. The Senior Health Equity Specialist leverages feedback from providers, members, vendors and community based organizations in the development of strategy and implementation and makes recommendations for CLAS and Health Equity efforts as aligned with contractual, accreditation and quality improvement opportunities to senior management. - Implements and manages programs in compliance with contracts and regulations and monitors ongoing program performance to maintain compliance. - Develops strategies and policies to deliver C&L services and maintain compliance with regulatory and contractual obligations. - Develops, interprets and communicates policies, procedures, regulations and standards. - Develops California State Health Programs (Medi-Cal) contract content for C&L services, for Medi-Cal, Healthy Families, and Healthy Kids products. - Prepares P&P’s for committee adoption. - Implements activities to meet regulatory obligations. - Monitors compliance with California regulations and State Health Programs contractual obligations - Assesses operational gaps compared to new standards and makes recommendations to senior management. - Represents Health net to Regulators and Accreditation Agencies, demonstrating the provision of culturally & linguistically appropriate health care services. - Liaisons between community coalitions, California and local regulators, vendors, accrediting bodies and Health Net senior management to increase knowledge of new C&L standards and ensures contract requirements, goals and regulatory are met. - Monitors/evaluates translation services and interpreter services. - Evaluates externally translated materials from vendors and provides recommendations to vendor management/contracting. - Identifies and resolves compliance issues/quality issues related to translating material. - Identifies and resolves compliance issues/quality issues related to the provision of interpreter services. - Reviews the translation process and translated materials for improvement opportunities. - Manages Community Advisory Committees - Develops regional goals, outcomes and objectives for Committees. - Represents and articulates local or regional needs to senior management committees - Develops C&L programs to enhance access to care for members and providers based on geographic, cultural, and linguistic data - Develops teaching to standard modules for associates - Develops teaching to standard modules for providers - Reviews member and provider material for cultural and linguistic appropriateness. - Monitors grievance and appeals processes for C&L issues. - Proactively identifies areas of improvement for the department and participates in development of improvement plans. Education/Experience: Bachelor’s in Cultural Anthropology, Social Work, Medical Anthropology, Public Health or related field required. Masters preferred. 5+ years of experience in government, health, or community programs. Experience in managed care preferred. Pay Range: $70,100.00 - $126,200.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
Moving Help Specialist
U-HaulSince 1945, U-Haul has been serving do-it-yourself movers and their households.
Location: 2727 N Central Ave, Phoenix, Arizona 85004 United States of America U-Haul is looking for an organized, friendly, and motivated call center representative who can work out of our Phoenix office or remote! This position entails helping customers book, edit, reschedule, and/or cancel Moving Help services via phone, chat, and email. To do well in this role, you need to be able to remain calm when customers are frustrated and have experience working with computers. SHIFT SCHEDULE: Part-time and Full Time Available - Days Vary: Monday through Sunday - Hours Vary: 6:00 a.m. - 4:00 p.m. - Initial training hours: Monday-Friday 7:30am–4pm for four weeks. - Holidays Compensation: $15.00/Hr Customer Support Specialist Responsibilities: - Maintaining a positive, empathetic, and professional attitude toward customers at all times. - Responding promptly to customer inquiries. - Communicating with customers through phone calls, chats, and emails. - Acknowledging and resolving customer complaints. - Processing, rebooking, and modifying orders. - Keeping records of customer interactions, transactions, comments, and complaints. - Communicating and coordinating with colleagues and supervisors as necessary. - Providing feedback on the efficiency of the customer service process. - Ensure customer satisfaction and provide professional customer support. Customer Support Specialist Requirements: - High school diploma or GED. - Ability to stay calm when customers are stressed or upset. - Comfortable using computers. - Experience working with customer support. Perks of joining the U-Haul fleet: Get your career moving with a company that empowers team members to be the healthiest version of themselves! We provide robust wellness benefits, events, and resources to help team members become the happiest and healthiest they can be. Here are just some of the programs U-Haul has available: - Full Medical coverage - New indoor fitness gym - Onsite medical clinic for you and your family - Career stability - Opportunities for advancement - Valuable on-the-job training - Prescription plans - Dental & Vision Plans - Business and travel insurance - YouMatter Employee Assistance Program - Paid holidays, vacation, and sick days - Employee Stock Ownership Plan (ESOP) - 401(k) Savings Plan - Life insurance - Critical Illness/Group Accident - 24-hour physician available for kids - Subsidized gym/ membership - MetLaw Legal program - MetLife auto and home insurance - Discounts on cell phone plans, hotels, and more - LifeLock identity Theft - Tuition reimbursement program - Free online courses for personal and professional development at U-Haul University - Savvy consumer wellness programs- from health care tips to financial wellness - U-Haul federal credit union U-Haul Holding Company, and its family of companies including U-Haul International, Inc. (“U-Haul”), continually strives to create a culture of health and wellness. Consistent with applicable state law, U-Haul will not hire or re-hire individuals who use nicotine products. The states in which U-Haul will decline to hire nicotine users are: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Pennsylvania, Texas, Utah, Vermont, Virginia, and Washington. U-Haul has observed this hiring practice since February 1, 2020 as part of our commitment to a healthy work environment for our team. U-Haul is an equal opportunity employer. All applicants for employment will be considered without regard to race, color, religion, sex, national origin, physical or mental disability, veteran status, or any other basis protected by applicable federal, provincial, state or local law. Individual accommodations are available on requests for applicants taking part in all aspects of the selection process. Information obtained during this process will only be shared on a need to know basis.
Revenue Cycle Billing Coordinator (Regional Hospital Billing) - REMOTE
Vanderbilt University Medical CenterBased in Nashville, Tennessee, Vanderbilt University Medical Center (VUMC) is a comprehensive healthcare facility and a leader in medical research, education, a
Discover Vanderbilt University Medical Center: Located in Nashville, Tennessee, and operating at a global crossroads of teaching, discovery, and patient care, VUMC is a community of individuals who come to work each day with the simple aim of changing the world. It is a place where your expertise will be valued, your knowledge expanded, and your abilities challenged. Vanderbilt Health is committed to an environment where everyone has the chance to thrive and where your uniqueness is sought and celebrated. It is a place where employees know they are part of something that is bigger than themselves, take exceptional pride in their work and never settle for what was good enough yesterday. Vanderbilt’s mission is to advance health and wellness through preeminent programs in patient care, education, and research. Organization: Regional Hospital Billing Job Summary: The Revenue Cycle Billing Coordinator is responsible for evaluating and managing revenue cycle operations to ensure effective and compliant billing and reimbursement processes. This role designs, executes, and implements billing procedures, oversees program development, and supports continuous improvement initiatives that impact a significant segment of the organization. . KEY RESPONSIBILITIES - Assist with designing, planning, and implementing billing procedures and systems to support new and existing services. - Provide training and ongoing guidance to staff involved in billing and revenue cycle functions. - Promote program growth and scalability to support organizational expansion. - Handles claim processing, including payments, adjustments, refunds, denials, and outstanding balances from both patients and insurers. - Acts as a point of contact between insurance providers, third-party payers, and administrative staff. - Evaluates financial data to detect, reconcile, and resolve trends that lead to incorrect or missing reimbursements. - Conducts comprehensive account audits and manages other complex tasks and projects. - Performs additional duties as assigned, in accordance with the general scope of the role. TECHNICAL CAPABILITIES - Revenue Cycle (Intermediate): Knowledge of the financial process to track patient care from registration and scheduling to the final payment of a balance. - Problem Solving (Intermediate): Uses critical thinking and process improvement, identifies root causes, creates future state, coaches and mentors, development of solutions and action plans with a sustainability plan. Applies appropriate tools to address issues. - Communication of Results (Intermediate): Communicates results and recommendations to customers in a concise and non-technical format. Clearly states implications and potential next steps. Presents analysis, ideas, and findings using the appropriate data visualization and presentation tools [such as Word, Excel, Tableau, and PowerPoint]. - Quality Assurance (Novice): Understands the goal of increasing organizational productivity and individual performance by making the products and services within your work assignments more efficient and more effective. - Regulatory Compliance (Intermediate): Demonstrates knowledge of the appropriate rules and regulations and apply them in difficult, stressful and complex situations. Able to interpret and explain rules and regulations that are ambiguous or unclear. Directs others in interpreting rules and regulations on the job and trains others in them. - Business Results (Intermediate): Ability to achieve business results while focusing on quality, customer satisfaction, and stewardship. Our professional administrative functions include critical supporting roles in information technology and informatics, finance, administration, legal and community affairs, human resources, communications and marketing, development, facilities, and many more. At our growing health system, we support each other and encourage excellence among all who are part of our workforce. High-achieving employees stay at Vanderbilt Health for professional growth, appreciation of benefits, and a sense of community and purpose. Core Accountabilities: Organizational Impact: Executes job responsibilities with the understanding of how output would affect and impact other areas related to own job area/team with occasional guidance. Problem Solving/ Complexity of work: Analyzes moderately complex problems using technical experience and judgment. Breadth of Knowledge: Has expanded knowledge gained through experience within a professional area. Team Interaction: Provides informal guidance and support to team members. Core Capabilities : Supporting Colleagues:- Develops Self and Others: Invests time, energy, and enthusiasm in developing self/others to help improve performance e and gain knowledge in new areas.- Builds and Maintains Relationships: Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships.- Communicates Effectively: Recognizes group interactions and modifies one's own communication style to suit different situations and audiences. Delivering Excellent Services:- Serves Others with Compassion: Seeks to understand current and future needs of relevant stakeholders and customizes services to better address them.- Solves Complex Problems: Approaches problems from different angles; Identifies new possibilities to interpret opportunities and develop concrete solutions.- Offers Meaningful Advice and Support: Provides ongoing support and coaching in a constructive manner to increase employees' effectiveness. Ensuring High Quality: - Performs Excellent Work: Engages regularly in formal and informal dialogue about quality; directly addresses quality issues promptly.- Ensures Continuous Improvement: Applies various learning experiences by looking beyond symptoms to uncover underlying causes of problems and identifies ways to resolve them. - Fulfills Safety and Regulatory Requirements: Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring. Managing Resources Effectively: - Demonstrates Accountability: Demonstrates a sense of ownership, focusing on and driving critical issues to closure.- Stewards Organizational Resources: Applies understanding of the departmental work to effectively manage resources for a department/area.- Makes Data Driven Decisions: Demonstrates strong understanding of the information or data to identify and elevate opportunities. Fostering Innovation:- Generates New Ideas: Proactively identifies new ideas/opportunities from multiple sources or methods to improve processes beyond conventional approaches.- Applies Technology: Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges.- Adapts to Change: Views difficult situations and/or problems as opportunities for improvement; actively embraces change instead of emphasizing negative elements. Position Qualifications: Responsibilities: Certifications: Work Experience: Relevant Work Experience Experience Level: 3 years Education: High School Diploma or GED (Required) Vanderbilt Health is committed to fostering an environment where everyone has the chance to thrive and is committed to the principles of equal opportunity. EOE/Vets/Disabled.
Billing Supervisor
Fish & RichardsonFish & Richardson has provided legal services, with a focus on technology and patent law, since 1878. Founded by Frederick Fish, a Boston, Massachusetts patent
• Oversee team in its day-to-day activities while adhering to the firm’s policies and procedures • Train employees on policies relating to billing and collections • Ensure accurate generation and timely submission of client invoices • Oversee research and resolution of all invoice rejections • Review new contracts and incorporate them into billing systems • Oversee quality control functions for billing and collections • Provide leadership regarding resolution of issues • Maintain open communication with billing attorneys and assistants • Lead process improvement efforts in billing processes • Assist with month-end and year-end closings • Identify staff developmental needs and provide guidance and training



