Obtain and secure prior authorization for high end radiology and/or hospital scheduled admissions and/or specialty patients for all Geisinger Health System.. Verifies and completes insurance verification on such studies to ensure patient has coverage prior to appointment date. Establish and maintain communication with all necessary GHS providers, nurses, and office staff to ensure completion on all peer to peer review and denials. Maintains a close working relationship with the staff of the assigned clinical departments, to ensure clear communication and handling of all patients needs. Provides accurate and efficient service to patients. Addresses and coordinates Revenue Cycle processes. Acts as a liaison for all financial matters to insurance companies, GHS departments, patients and/or other Revenue Cycle teams/departments. The Specialist will be responsible for providing customer service excellence in a professional manner and will serve as the voice of the Geisinger Health System when interacting with the public on a daily basis.
Performs duties to support the goals and objectives of the Geisinger Health System in its efforts to provide the highest level of quality patient care and patient satisfaction.
Directly accountable to the Supervisor, Revenue Cycle.
Competencies and Skills:
Demonstrates both oral and written communication skills. Must be able to maintain confidentiality. Must be able to make responsive, sound and accurate decisions.
Demonstrates ability to be professional, resourceful, confident, and maintain a pleasant, receptive manner.
Demonstrates customer service skills and telephone etiquette.
Demonstrates ability to organize/prioritize work, ability to draw from and utilize numerous data sources, be detailed oriented and multi-task.
Demonstrates ability to perform mathematical calculations (percentages, ratios) and basic clerical skills (telephone, computer, photocopier, and fax).
Demonstrates knowledge of federal, state, third party insurances and assistance programs.
Demonstrates basic computer skills including Microsoft office required. Knowledge of automated billing systems (EPIC, IDX, Passport and all other GHS applications) preferred.
Demonstrates the ability to interpret basic healthcare financial information and advise customers.
Demonstrates the ability to spell correct diagnoses, procedures, patient names.
Demonstrates excellent customer service and strong communication skills.
Demonstrates the ability to type/enter data accurately.
Must be highly motivated to improve data quality and financial position of the institution.
Demonstrates the ability to perform as a team player.
Must be assertive, show initiative in seeking information and financial payments.
Must be able to work autonomously.
Must use critical thinking skills to determine the best financial options for patients.
Education and or Experience:
High school diploma or equivalent required.
Minimum of two years previous experience in Healthcare environment with focus on Registration or Financial Services required.
Previous experience in medical terminology preferred.
Previous experience with InterQual and Medicare Inpatient criteria preferred.
Previous experience with CPT and ICD-9 Coding preferred.
Previous experience with precertification and insurance verification preferred.
Overall knowledge of the revenue cycle and accounts receivable preferred.
Bilingual ability a plus but not required.
Experience with Patient Access ADT and Patient Financial systems preferred.
Up to six months to learn all aspects of the job, including but not limited to; insurance verification, precertification and the demonstrated ability to effectively communicate with the appropriate providers, clinics, insurance companies and facilities as described in the Revenue Cycle Policies and Procedures.
Working Conditions/Physical Demands:
Work is typically performed in an office environment
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
ABOUT GEISINGER: Geisinger is a physician-led health system comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 13 hospital campuses, two research centers, and a 583,000-member health plan Geisinger is nationally recognized for innovative practices and quality care. Geisinger serves more than 3 million people in central, south-central and northeast Pennsylvania and also in southern New Jersey with the addition of National Malcolm Baldridge Award recipient AtlantiCare, A member of Geisinger. In 2017, the Geisinger Commonwealth School of Medicine became the newest member of the Geisinger Family.
We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.* Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. For more information, visit www.geisinger.org, or connect with us on Facebook, Instagram, LinkedIn and Twitter.
** Does not qualify for J-1 waiver. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
*Domestic partner benefits not applicable at Geisinger Holy Spirit.
At Geisinger, our innovative ideas are inspired by the communities we serve – like our Fresh Food
Farmacy, a program that delivers life-saving healthy alternatives to patients with diabetes. With additional tools like our MyCode Community Health Initiative, one of the first health system genome sequencing
programs, and our new asthma app suite that we developed in partnership with AstraZeneca, it’s no wonder we’re ranked one of the Top 5 Most Innovative Healthcare Systems by Becker's Hospital Review. We continually work towards continuous improvement in a culture where everyone has a voice and firmly believe that better begins with all of us.
Founded more than 100 years ago, Geisinger serves more than three million residents throughout central, south-central and northeastern Pennsylvania and southern New Jersey. Our physician-led system is comprised of 30,000 employees, including 1,600 employed physicians, and consists of 13 hospital campuses, the Geisinger Health Plan, Geisinger Commonwealth School of Medicine and two research centers.
What you do at Geisinger shapes the future of health and improves lives – for our patients, communities, and you.