Allegheny Health Network Careers

Date Posted: 12/8/2016

Position Number: 54834

Location: 4 Allegheny Center

Allegheny Health Network is an integrated delivery network focused on preserving health care choice and providing affordable, high-quality care to the people in our communities.  With more than 14,000 employees including 7,400 health care professionals, nearly 200 primary care and specialty care practices, Allegheny Health Network includes seven hospitals in Pennsylvania with nearly 2,400 licensed beds.

Allegheny Health Network’s clinical expertise ranges from primary care to the most complex surgical procedures.  Services include cancer diagnosis and treatment, cardiovascular care, neurological and neurosurgical services, organ transplantation, orthopedic and rehabilitation services, and women’s health.

Department: Insurance Coordination

Status: Full-time

Shift: Daylight, occasional evenings

Union/ Non-union:  Non-union

Job Summary:

• Performs all scheduling/pre-registration functions, verifies health insurance coverage, obtains detailed benefit information, validates authorization, calculates, collects and posts patient liabilities. Communicates revenue cycle related issues as needed. Contacts patients/physician offices, case managers and/or social workers to obtain complete and accurate demographic and insurance information.

Job Responsibilities:

• Utilizes applicable worklists, faxes and phone calls to conduct scheduling/pre-registration functions, provides necessary pre-procedure instructions, validates patient demographic data, performs ABN check to determine medical necessity, verifies and obtains detailed medical benefits, assigns accurate plan code and COB order.
• Corrects/updates all necessary data to assure timely and accurate bill submission. Verifies all insurance information through payor contact via telephone or online resources. Notifies patient placement for bed assignment as applicable. (50%)
• Identifies payor authorization/referral requirements. Provides appropriate documentation and follow up to physician offices, scheduling/registration departments, case management department and/or payors regarding authorization/referral deficiencies. (15%)
• Identifies all patient financial responsibilities, calculates estimates, collects liabilities, communicates liability estimation to patient, post payment transactions as appropriate in the ADT system and conducts daily reconciliation of cash received for management review/sign off. After thorough investigation, identifies selfpay accounts and complex liability pricing calculations and escalates account to financial counselors as applicable. (15%)
• Maintains strict adherence to and compliance with all internal and external policies, procedures, rules, regulations, patient confidentiality and HIPPA privacy. Remains current on all regulations, policies and procedures and process changes that are essential to completing assigned daily tasks. (10%)
• Cooperates with and maintains excellent working relationships with patients, WPAHS leadership and staff, physician offices and designated external agencies or vendors. Performs any written or verbal communication necessary to exchange information with designated contacts. (10%)
• Performs other duties as assigned or required.

Requirement:

• Ability to work under minimal supervision. Perform duties in accordance with departmental guidelines. Ability to effectively communicate both written and verbal.
• Ability to multi task and identify priorities
• Experience operating PC and using software and various websites applications required.
• Excellent customer service and communication skills.

Preferred Requirement:

• Associate's Degree preferred.
• 2 years patient access/healthcare experience preferred.
• Preferred knowledge of health insurance benefits.
• Preferred experience with telephone interaction to obtain information/collect patient liabilities.