Pre-bill Denial Unworked Pdu

Job Summary:

The Health Care Specialist will review post-discharge, prebill accounts that do not have authorization on file, ALOS versus days authorized variances, and/or other account discrepancies identified that will result in the account being denied by the payor that does not require a clinical review.

Communicates with third-party payors to resolve discrepancies prior to billing. Accurately and concisely documents all communications and actions taken on the account in accordance with policies and procedures. The Prebill Denials Analyst will escalate medical review requests and/or denial activities to the Prebill Denials Nurse.

Responsibilities:

• Work prebill accounts imported into the PDU Tool efficiently and effectively on a daily basis to resolve accounts with "no auth numbers and ALOS vs. authorized days variances
• Work assigned accounts in eRequest to resolve outstanding issues
• Report insurance denial trends identified during daily operational assignments
• Identify problem accounts and escalate as appropriate
• Document actions taken on the account clearly and concisely
• Contacting the facilities, physicians' offices and/or insurance companies to resolve denials/appeals
• Adhere to time and attendance policies
• Adhere to all policies and procedures, including phone and internet usage, break utilization, etc.
• Participate in ongoing education and training as needed
• Establish and maintain relationships with all customers
• Seeks assistance from immediate supervisor when in situations which are unclear or ambiguous
• Adheres to established policy and procedure and escalates issues through the established Chain of Command
• Demonstrates commitment to teamwork and cooperation
• Practice and adhere to the "Code of Conduct" philosophy and "Mission and Value Statement"
• Other duties as assigned

Skills and Experience:

• English
• Spanish Language (Oral and writing 85% or higher), (B2+ or above).
• Must have a high school diploma or in progress to complete high school.
• At least 1 year of experience in Customer Service positions.
• The resource will adjust its local schedule with the resources supporting this position during Daylight Savings time changes in the Eastern Time Zone.
• Knowledge of the medical insurance process is a plus
• Perform and track multiple tasks accurately in short timeframes, have the ability to work quickly and accurately in a fastpaced environment while managing multiple demands.
• Ability to work both independently and collaboratively as a team player
• Attention to detail.

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