Billing Auth Rep -Burn/Wound Outpatient M-F 8-5

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Work Shift

This Billing authorization representative will be responsible for the day-to-day insurance pre-certification and re-certification of wound care procedures and hyperbaric treatments.

Minimum 2 years Medical practice, hospital billing/coding experience or similar office experience Preferred

• CCS - Cert Coding Spec
• CPC - Cert Prof Coder
• RHIA - Reg Health Information Admin
• RHIT - Reg Health Information Tech

Job Summary:

This position reports directly to the nurse manager. This position is responsible for accurate and timely insurance pre-certification and re-certification of wound care procedures and hyperbaric treatments. Reviewing documentation in the medical record and accurately and completely assigning appropriate diagnostic and procedural ICD-9-CM and /or CPT-4 HCPCS codes to the greatest specificity. Completes audits for all patient accounts as assigned. Collaborates with contracted partner to overturn denials and respond to patient referral work queues. Act as a liaison between the department, facility, the system, and the partner contracted financial services.

Core Responsibilities and Essential Functions:

3) Insurance verification, authorization, certification, and denials
a) Verify documentation and physician order that supports medical necessity for procedure.
b) Request and/or ensure completion of pre-authorizations, pre-certifications and/or re-certifications for treatment.
c) Follow up on past due patient accounts and insurance claims in the work queues for the service line (failed bills produced by the hospital system).
d) Work to have denials overturned for the burn service line, wound and HBO through collaboration with contracted partner.
e) Handle internal and external inquiries about insurance, account status, and general financial counseling.
f) Research and data collection on CPT/coding guideline changes for all payors.
g) Act as a liaison between the department, facility, the System, and the partner contracted financial services.
h) Coordinates with physicians offices and hospital departments regarding Burn, Wound and Hyperbaric patient referrals.
i) Relay patient authorization and insurance information to physicians offices and various hospital
j) j) Creates initial appointment in the centers specific EMR (WebPT and Wound Expert) and initiates authorizations for patients receiving PT/OT advanced treatments (PT/OT, Hyperbaric Oxygen Therapy, and other advanced modalities)
1) Front office duties:
a) Greeting patients and guests in a warm, friendly manner in person or on the telephone; identifying self and practice.
b) Registering/scheduling patients for appointments; ensuring patient eligibility through Experion, checking in patients, scanning insurance cards and ID into the EHR, and ensuring completion of all necessary paperwork.
c) Communicating quickly and often with patients if there is a delay or wait for patient care.
d) Checking patients out and scheduling next appointment visits.
e) Answering incoming calls; directing to appropriate personnel, taking messages when appropriate, handling issues they can address, and scheduling patient appointments as requested.
f) Managing patient call wait times; being alert to queues in the system, responding to voicemails and messages timely, offer options to call patients back if they are on hold too long.
g) Other duties as assigned by management.
2) Coding and charting
a) Process daily charges and double check CCI edits and undocumented charges
b) Review daily appointment schedule and reconcile with end of day charges through revenue and usage
c) Balance charges: total charges on all accounts in the batch and match to those posted
d) Verify all CPT and ICD-10 codes are charged correctly, and appropriate paperwork is filed
5) Auditing for compliance
1. Complete CMS audits
2. Audit charges per patient as their treatment is completed.
3. Audit and analyze all charges generated by the department from the previous day
4. Audit of Detail Transaction Report provided by the financial team for denials being worked up by other departments.
4) Program training and partnership with referral sources
a) Develop and implement patient, physician, and team member training on insu