Healthcare Specialist

hace 7 días

Heredia, Costa Rica Auxis A tiempo completo

Job Summary:
The Healthcare Specialist will review post discharge, prebill accounts that do not have an 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 do not require a clinical review. Communicates with third party payors to resolve discrepancies prior to billing. Accurately and concisely documents all communications and action taken on the account in accordance with policies and procedures. The Healthcare Specialist will escalate medical review request 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 Level B2+ / C1
- High school diploma
- One year of CS and Back Office experience required. Experience in the following areas: appeals, denials, managed care, verifications/notification, precertification experienced preferred
- ** Communication** - communicates clearly and concisely, verbally and in writing. This includes utilizing proper punctuation, correct spelling and the ability to transcribe accurately.
- ** Customer orientation** - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
- ** Interpersonal skills** - able to work effectively with other employees, patients and external parties
- ** Policies & Procedures** - demonstrates knowledge and understanding of organizational policies, procedures and systems
- ** Basic skills** - demonstrates ability to organize, perform and track multiple tasks accurately in short timeframes, have ability to work quickly and accurately in a fast-paced environment while managing multiple demands, ability to work both independently and collaboratively as a team player, adaptability, analytical and problem solving ability and attention to detail and able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately.

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