Prior Authorization Advocate

Why work for Nebraska Methodist Health System?

At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we serve and people we employ. We call it The Meaning of Care - a culture that has and will continue to set us apart. It's helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient's needs, or giving a high five when a patient beats a disease or conquers a personal health challenge. We offer competitive pay, excellent benefits and a great work environment where all employees are valued! Most importantly, our employees are part of a team that makes a real difference in the communities we live and work in.

Job Summary:

Location: Methodist Physicians Clinic - Jennie Ed Medical Plaza

Address: 808 E Pierce St. Council Bluffs, IA 51503

Work Schedule: Monday through Friday 7:30am to 4:00pm or 8:00am to 4:30pm

Performs a variety of duties as an advocate for clinic patients. Ensures patients are educated on the estimated cost of care and responsible to collecting payments from patients. Performs authorizations in an efficient manner to ensure timely care.

Responsibilities:

Essential Job Functions

Serve as an advocate for new patients to Methodist Physicians Clinic.

• Creates patient estimates.
• Speaks directly with each patient to review estimated cost of care and payment policies.
• Assists with FMLA, Disability or other forms in a timely manner.

Verify benefits and obtains authorization using electronic sources to improve efficiency in obtaining authorizations ensuring timely care is provided.

• Document medical necessity checking outcome.
• Generate waiver / Advanced Beneficiary Notice (ABN) if medical necessity checking does not meet payer criteria, patient is seeking care for a non-covered benefit, or a self-pay patient.

Assists, counsels, and suggests problem solving techniques to patients as they relate to prompt payment of accounts by following department policies to ensure timely resolution of account.

• Processes paperwork by reviewing accounts that have filed bankruptcy then forwards to the immediate supervisor for adjustment.
• Provides patient assistance when needed regarding resolving billing issues, refund, or collection problems, insurance questions including Medicare/Medicaid by following established policies for account resolution and patient satisfaction.
• Assists patients with community resources when needed. Works with drug companies when needed to secure financial assistance for patients.
• Assists patients with Every Women Matters.

Manages patient accounts. Responsible for the proper documentation on patient accounts regarding financial arrangements, insurance coverage, special instructions from physicians, and other pertinent information needed to ensure proper handling of the account.

• Verifies insurance or determine if self-pay.
• Set up account and payment plans. Monitors payments.
• Complete work associated with insurance change during.

Responsible for the daily deposit and daily return mail.

• Open safe in am and distribute bags. Secure bags at end of day in safe.
• Prepare daily deposit for pick up.
• Reviews daily return mail by checking status of accounts on computer and determines any action to be taken using appropriate skip tracing techniques to facilitate timely billing of patients.

Maintains patient confidentiality within the area by following office procedures to ensure all information is correct.

Effectively communicates with other department personnel, nurses, physicians, attorneys, insurance companies, and all other parties, by phone or mail, to maintain professional handling of all situations in relation to patients' accounts.

Schedule:

Work Schedule: Monday through Friday 7:30am to 4:00pm or 8:00am to 4:30pm

no weekends or holidays

Job Description:

Job Requirements

Education

• High school diploma, GED or equivalent combination of education and experience.
• Post-Secondary education in a healthcare fiend (e.g. CNA, CMA, etc.) preferred.

Experience

• 2 years of healthcare experience required, including electronic medical required.
• Registration, insurance, or prior-authorization experience preferred.
• OB/GYN office experience preferred.

License/Certifications

• N/A

Skills/Knowledge/Abilities

• Knowledge of Current Procedural Terminology (CPT) and International Classification of Disease (ICD) codes.
• Skill using computers and office equipment.
• Skill in organizing and prioritizing work.
• Knowledge of Insurance billing, payment collection practice and revenue cycle, preferred.
• Extensive customer contact.
• Skilled in time management.
• Skilled in oral and written communication.
• Ability to work under limited supervision and stressful conditions.
• Ability to adhere to all workplace and safety requirements, regulations, standards, and practices.
• Ability to travel to rotating work sites.

Physical Requirements

Weight Demands

• Light Work - Exerting up to 20 pounds of force.

Physical Activity

• Not necessary for the position (0%):

• Climbing

• Crawling

• Kneeling

• Occasionally Performed (1%-33%):

• Balancing

• Carrying

• Crouching

• Distinguish colors

• Lifting

• Pulling/Pushing

• Standing

• Stooping/bending

• Twisting

• Walking

• Frequently Performed (34%-66%):

• Fingering/Touching

• Grasping

• Keyboarding/typing

• Reaching

• Repetitive Motions

• Sitting

• Speaking/talking

• Constantly Performed (67%-100%):

• Hearing

• Seeing/Visual

Job Hazards

• Not Related:
• Chemical agents (Toxic, Corrosive, Flammable, Latex)
• Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)
• Physical hazards (noise, temperature, lighting, wet floors, outdoors, sharps) (more than ordinary office environment)
• Equipment/Machinery/Tools
• Explosives (pressurized gas)
• Electrical Shock/Static
• Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc)
• Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
• Mechanical moving parts/vibrations

About Methodist:

Nebraska Methodist Health System is made up of four hospitals in Nebraska and southwest Iowa, more than 30 clinic locations, a nursing and allied health college, and a medical supply distributorship and central laundry facility. From the day Methodist Hospital was chartered in 1891, service to our communities has been a top priority. Financial assistance, health education, outreach to our diverse communities and populations, and other community benefit activities have always been central to our mission.

Nebraska Methodist Health System is an Affirmative Action/Equal Opportunity Employer and does not discriminate on the basis of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation, gender identity, or any other classification protected by Federal, state or local law.