Authorization & Billing Support Specialist, Senior

SB Clinical Practice Management•Town of Brookhaven, NY

13h

About The Position

This Senior Authorization & Billing Support Specialist position assists the Medical Coding Manager with the day-to-day operations of the coding unit. The role provides general administrative and clinical office support, acting as a liaison between patients and physicians regarding insurance policies and procedures. It is a full-time position with a schedule of Monday through Friday, 8:30 AM to 5 PM. The compensation philosophy aims to provide marketable compensation programs and to compensate employees based on relevant experience and education. Individual compensation discussions begin during the hiring process and may occur during job review and promotional opportunities. Salaries vary depending on experience, education, and current market for the position, with Human Resources determining the external and internal equitable salary for each employee. The provided salary range represents Stony Brook CPMP’s good faith and reasonable estimate of possible compensation at the time of posting.

Requirements

Associate’s degree; in lieu of degree, an additional 2 years of experience working in a physician practice or healthcare environment.
Three (3) years of full-time experience working in a physician practice or healthcare environment.
Knowledge of insurance verification/update, scheduling, assist with prior pre-authorization or obtaining referrals process experience.
Strong organizational and communication skills (both verbal and written).
Excellent attention to detail.
Exceptional telephone etiquette.
Proficient in Microsoft Office.

Nice To Haves

Bachelor’s Degree.
EMR experience – Cerner/IDX.
Experience with patient scheduling.

Responsibilities

Validate patient insurance.
Appeal denials, write appeal letters giving medical necessity and provide medical records to support the appeal.
Review Task Manager regularly, respond to denials and open encounters posted to Task Manager, make corrections.
Administrate insurance websites, oversee passwords.
Collect insurance referrals and prior authorization for testing and procedures.
Authorize and manage Neuro Psychiatric Testing.
Ensure the approvals for the authorizations are in the EMR and CERNER systems.
Promote department goals by training team members on insurance policies.
Stay current on guidelines set by insurance.
Educate staff and providers on insurance policies.
Act as a resource with regards to insurance and coding policies and procedures to both staff and providers.
Act as liaison and problem solver between physician and staff with regards to coding and charge entry.
Provide resolution to coding related issues based on industry coding best practices.
Analyze, code and abstract information for the purpose of assigning and entering appropriate and consistent diagnoses and procedure codes for reimbursement.
Resolve discrepancies on coding related issues.
Analyze and understand reasons for denials.
Document trends of denials to share with department, and provide in-service for continuous improvement.
This includes changes of internal system, carrier updates, functions, and duties & processes impacting billing cycles.
Inform staff and self pays of UH financial aid applications and Medicaid applications.
Ensure all data are accurately documented in the EMR and scanned into CERNER.
Provide data to CPMP Patient Accounts as requested for patient inquiries.
Initiate Source Document to add new CPT Codes to Patient Keeper and Cerner.
Proactively identify and implement opportunities for process improvements.
Attend meetings and all other duties as assigned.