Insurance/Billing Rep - Interventional - HPW - Full-time - Day

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region. Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates. The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time). Pay Range: $19.32 - $24.13 Scheduled Weekly Hours: 40 Position Overview SUMMARY (Basic Purpose of the Job) Supports the Interventional Service Line by providing patient scheduling. Ensures that all scheduled patient visits have accurate and valid insurance authorizations and/or referrals prior to the date of service. Assists the service line with daily billing, charging, charge corrections when claims are denied, require retro adjustments based on procedural coding and CMS edits. MINIMUM REQUIREMENTS Education: High school diploma or GED. Experience: Two years of scheduling, insurance, authorization or billing related experience in a healthcare related setting. Medical office training or medical certification accepted in lieu of experience. Other Credentials: Knowledge and Skills: Strong verbal and written communication skills. Excellent interpersonal and organizational skills. Knowledge of insurance authorization/referral requirements preferred. Special Training:Proficient computer and telephone skills. Familiarity with medical terminology. Mental, Behavioral and Emotional Abilities: Ability to problem solve and multi-task. Usual Workday:8 Hours ESSENTIAL FUNCTIONS Works collaboratively with scheduling, clinical and data entry staff to fully understand patient scheduled and completed visits, and the status of each patient’s insurance. Gathers all necessary paperwork and contacts insurance company for authorizations and referrals as appropriate prior to dates of service by phone or electronic communication. Obtains accurate and valid authorizations and referrals from various insurance companies prior to dates of service. Obtains and advises patients of all necessary authorizations and referrals needed to ensure financial reimbursement. Communicates authorization and referral status to scheduling and clinical staff. Contacts insurance company for an updated authorization that reflects the actual services performed expediently. Communicates all authorization issues and concerns to management, and actively participates in authorization-related problem resolution. Maintains a current and thorough understanding of payer requirements related to authorizations and referrals for medical services. Performs all medical reception scheduling duties, including answering phones, scheduling appointments, making PAT reservations, contacting patient to confirm scheduled appointments, and notifies patient logistics of routine admissions for scheduled outpatient procedures. Gathers complete patient and procedure information and collaborates with physician's office to schedule cases while negotiating dates and times avoiding resource conflicts. Works with directors to schedule physician specific cases to maximize efficiency and productivity and coordinates the peer to peer authorization process when authorizations are denied. Works with the interventional staff and clinical financial specialist and acts as a resource for department on any issues related to interventional coding and billing adjustment based on audits and CMS edits. Works with the clinical team member, financial specialist, and department leadership to create and update procedural CDM codes as needed. Assists Medical Records, Corporate Compliance, or Finance with appeals process by providing necessary documentation. Performs other duties as assigned. PHYSICAL DEMANDS AND WORK ENVIRONMENT Frequent physical demands include Wrist position deviation, Keyboard use/repetitive motion Occasional physical demands include Standing, Walking, climbing (e.g., stairs or ladders), Carry objects, Push/Pull, Twisting, Bending, reaching forward, reaching overhead, Squat/kneel/crawl, Taste or Smell, Talk or Hear Continuous physical demands include: Sitting , Pinching/fine motor activities Lifting Floor to Waist 10 lbs. Lifting Waist Level and Above 10 lbs. Sensory Requirements include Accurate Near Vision, Accurate Far Vision, Accurate Color Discrimination, Accurate Depth Perception, Accurate Hearing Anticipated Occupational Exposure Risks Include the following: N/A This position is eligible for the following benefits: Medical Plan Prescription drug coverage & In-House Employee Pharmacy Dental Plan Vision Plan Flexible Spending Account (FSA) - Healthcare FSA - Dependent Care FSA Retirement Savings and Investment Plan Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance Supplemental Group Term Life & Accidental Death & Dismemberment Insurance Disability Benefits – Long Term Disability (LTD) Disability Benefits – Short Term Disability (STD) Employee Assistance Program Commuter Transit Commuter Parking Supplemental Life Insurance - Voluntary Life Spouse - Voluntary Life Employee - Voluntary Life Child Voluntary Legal Services Voluntary Accident, Critical Illness and Hospital Indemnity Insurance Voluntary Identity Theft Insurance Voluntary Pet Insurance Paid Time-Off Program The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level. The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria. Welcome to Capital Health's new career opportunity page. Here you will have access to view and apply to career opportunities in our hospital and physician practice locations. Equal Opportunity Employer Notice Capital Health Benefits