Healthcare Specialist
hace 3 semanas
Job Summary:
The Clinical Review 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. The role will communicate with third-party payors to resolve discrepancies prior to billing and accurately document all communications and actions taken on the account in accordance with policies and procedures.
**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
**Requirements**:
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 - Strong customer service skills - Excellent communication skills - Ability to work independently and collaboratively - Attention to detail - Comfortable multitasking in a high volume/high demand environment - Good presentation and a polite, tactful, and friendly character
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