Description

Purpose:
Creates the hospital account in EPIC and verifies insurance coverage and authorizations have been obtained for all scheduled inpatient and Short Procedure surgery cases prior to date of service.

Responsibilities:

• Enters authorization information onto Hospital Account in EPIC.
• Follows up on patient and Physician office concerns or questions.
• Incorporates new policies and procedures into daily responsibilities and asks supervisor questions when clarification is needed
• Maintains knowledge of third party requirements (referrals, prior authorizations, notification forms, COB, HMO, Worker's Compensation, Auto Insurance and Managed Care contracts) and insurance compliance.
• Make recommendations for improving department systems, policies and procedures.
• Creates hospital account records for all surgical cases. Accounts completed in a timely manner to improve customer satisfaction and allow for referral and authorization prior to patients arrival.
• Educates referring Physician offices on authorization / referral requirements for surgical procedures.
• Performs all other duties as assigned or deemed necessary in the department?s mission to serve patients.
• Reviews all inpatient and Short procedure surgery accounts for completion of registration and insurance data. Revises registration with correct insurance, demographics and guarantor information as necessary. Resolves complex insurance verification questions.
• Maintains working knowledge of insurance plans participating with UPMC Pinnacle.
• Acts as a liaison regarding billing questions as well as any changes staff need to make to a patient?s account to ensure acceptance of a claim.

Qualifications

• Associate degree with minimum of 1-year experience with insurance verification authorization or closely related field or a High School Graduate with 2-3 years of experience.
• Able to work in a fast-paced environment with minimal supervision.
• Able to communicate effectively, especially over the telephone.
• Medical terminology course completion is preferred. (80% Score within 6 months of employment)
• Working knowledge of insurance billing requirements.
• Computer experience.
• Preferred knowledge of EPIC and ICD-10 coding, with knowledge of EPT codes for surgical procedures

Licensure, Certifications, and Clearances:
Clearances must be dated within 90 days

• Act 34 with renewal
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  UPMC is an Equal Opportunity Employer/Disability/Veteran

Individuals hired into this role must comply with UPMC's COVID vaccination requirements upon beginning employment with UPMC. Refer to the COVID-19 Vaccination Information section at the top of this page to learn more.