• Reviewing daily inpatient and observation admission reports to identify accounts requiring payer notification.
• Submitting “Notification of Admission” requests to commercial, Medicare Advantage, Medicaid Managed Care, and other third-party payers in accordance with payer, regulatory, contractual, and client-specific requirements.
• Verifying coverage, eligibility, and account information prior to submission to support clean, accurate notifications.
• Documenting confirmation numbers, reference numbers, payer responses, and related communications in designated client and Guidehouse systems.
• Monitoring pending notifications, follow up on outstanding requests, and resolve issues within required timelines.
• Escalating accounts at risk for missed notification deadlines, authorization-related denials, or reimbursement impact.
• Collaborating with Utilization Review, Case Management, and other operational teams to obtain supporting clinical or account information as needed.
• Maintaining current working knowledge of payer-specific notification requirements, client workflows, and standard operating procedures.
• Identifying trends contributing to notification delays, defects, or denials and communicate improvement opportunities to leadership.
• Supporting quality assurance reviews, reporting activities, training reinforcement, and continuous performance improvement initiatives.
• Meeting or exceeding productivity, quality, timeliness, and service level expectations established by Guidehouse and client organizations.
