Job Family:Admitting Representative
Travel Required:None
Clearance Required:None
What You Will Do: The
Pre-Admitting Coordinator is responsible for obtaining precertification, and/or validating prior authorization statuses in support of insurance specific plan requirements for all commercial, government and other payors across hospital (inpatient & outpatient), ancillary and clinic/ambulatory environments. In addition, the Pre-Admitting Coordinator may be responsible for pre-appointment registration and insurance review to maximize the submission of a clean claim. Exemplifies the client's mission, vision and values and acts in accordance with both Guidehouse Managed Services and Community Memorial Healthcare policies and procedures.
Essential Functions and Responsibilities: - Reviews, collects and properly records demographic and insurance information required to properly address the customers' authorization requirements and identify any financial issues.
- Verifies patient's eligibility from resources provided by third party payers and portals and other on lines services.
- Collects and analyzes demographic, insurance and other information from the patient, guarantor and all other sources to accurately ensure financial clearance of scheduled procedure/services.
- Seeks information from the health plan and provides notification to clinical partners concerning missing/pending information required of the health plan to issue an authorization.
- Contact insurance companies to ensure prior approval requirements are met. Notify clinical partners of necessary medical information such as history, diagnosis, CPT codes and clinical notes required by the health plan to secure authorization.
- Consistently maintains authorization accuracy rates at and or above department standard in performance of registration and authorization duties.
- Excellent customer-service. Able to find resolution within the phone interaction satisfactory to the caller and/or having the knowledge when to escalate to their supervisor and ability to provide service recovery when needed.
- Interacts and collaborates with physician practices and hospital departments to resolve issues while also analyzing necessary information that will ensure hospital reimbursement.
- Appropriately informs the patients of hospital policies that govern the revenue cycle, the amount owed by the patients and explains hospital payment policy. Offers option of Financial Assistance and Charity to assist in acceptable resolution of estimated patient balance.
- Receives, escalates and or properly responds to telephone and electronic inquiries from patients, payers, physician practices, hospital departments and other persons and entities.
- Performs other duties as assigned for the operational effectiveness and success of the department.
- Interacts and collaborates with hospital departments to resolve issues while also analyzing necessary information that will ensure hospital reimbursement.
- Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Community Memorial Healthcare Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures to ensure adherence in a manner that reflects honest, ethical, and professional behavior. Guards to assure that HIPAA confidential medical information is protected and upheld.
- Performs registration functions consistent with Federal, State and Local regulatory agencies and payer requirements, and organizational policies and procedures, including but not limited to HIPAA privacy and security regulations, DNV and the No Surprises Act (NSA) mandate.
- Attends classroom, in person or computer-based training sessions held for the benefit of staff required by Guidehouse Managed Services and Community Memorial Healthcare compliance requirements.
- Serves as preceptor/trainers to new hires and orienteers.
- Serves as a mentor to new hires and assists in new hire orientation.
- Other duties as needed and assigned by the supervisor/manager.
Shift: This is a PART-TIME position, Day Shift (8:30AM start), 32 hours per week, Monday, Tuesday, Wednesday, Thursday with occasional weekends and/or holidays. Scheduled days to work may change depending upon hospital demand This position is located ONSITE at Community Memorial Hospital in Ventura, CA What You Will Need:- High school graduate or equivalent.
- One (1) year of experience in Patient Access/Revenue Cycle/Medical Billing/Financial Counseling OR Customer Service experience.
What Would Be Nice To Have:- Associate's degree and or Revenue Cycle certifications.
- Must have a basic understanding of the core Microsoft suite offerings (Word, PowerPoint, Excel).
- Excellent communication and outstanding customer service and listening skills.
- Basic keyboarding skills.
- Ability to analyze and interpret data.
- Critical thinking, sound judgment and strong problem-solving skills essential.
- Team oriented, open minded, flexible, and willing to learn.
- Ability to prioritize and function effectively, efficiently, and accurately in a multi-tasking complex, fast paced and challenging department.
- Ability to follow oral or written instructions and established procedures.
- Ability to function independently and manage own time and work tasks.
- Ability to maintain Quality Assurance, Productivity and other Key Performance Indicator (KPI) expectations/standards.
- Ability to maintain confidentiality.
- Experience within a hospital or clinic environment, a health insurance company, managed care organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting, or customer service.
- Knowledge of insurance and governmental programs, regulations, and billing processes e.g., Medicare, Medicaid/Medi-Cal, Social Security Disability, Champ VA, Supplemental Security Income Disability, etc., managed care contracts and coordination of benefits is highly desired.
- Working knowledge of medical terminology and anatomy and physiology is preferable.
The annual salary range for this position is $43,400.00-$65,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.
What We Offer: Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.
Benefits include:
- Medical, Rx, Dental & Vision Insurance
- Personal and Family Sick Time & Company Paid Holidays
- Position may be eligible for a discretionary variable incentive bonus
- Parental Leave
- 401(k) Retirement Plan
- Basic Life & Supplemental Life
- Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
- Short-Term & Long-Term Disability
- Tuition Reimbursement, Personal Development & Learning Opportunities
- Skills Development & Certifications
- Employee Referral Program
- Corporate Sponsored Events & Community Outreach
- Emergency Back-Up Childcare Program
About GuidehouseGuidehouse is an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, citizenship status, military status, protected veteran status, religion, creed, physical or mental disability, medical condition, marital status, sex, sexual orientation, gender, gender identity or expression, age, genetic information, or any other basis protected by law, ordinance, or regulation.
Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.
If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1- or via email at . All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.
Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.
