Full-Time Intake Position- Atlanta Georgia

ESSENTIAL FUNCTIONS:

·         Data Entry: (Weighting 10%)

To enter all information associated with a patient account accurately and within 24 hours of the time it is received by the Authorization Department.

 Â·         Enter data efficiently in order to meet the performance standards established for this position.

·         Responsible for entering data according to the procedures laid out in the procedure manual.

·         Be able to determine which if any documents are missing from an order that would prevent its processing, and to accurately log those documents in the patients’ profile.

·         Responsible for completing daily self-audits to ensure the accuracy of his/her work.

·         Be able to simultaneously enter data and complete benefit verifications & authorizations.

·         Alert supervisor to any issues or abnormalities encountered throughout the workday.

           Authorization and Account Management: (Weighting 40%)

To verify the insurance benefits and complete any necessary pre-certifications or pre-authorizations for all patients s/he enters into the system prior to the patients’ rental start date (in situations wherein the rental period has already commenced upon receipt of the order, benefits should be verified and pre-authorizations obtained within 48 hours. To manage the patient account so that you represent ERMI INC. in the best possible light,

·         Obtain benefit information for all patients, and request pre-certification as needed.

·         Responsible for verifying the claims address with the payor to ensure that the claim is sent to the appropriate office.

·         All calls for verifications and authorizations should be initiated within 24 hours of order entry.

·         Pre-Authorize all orders with Worker’s Compensation and commercial Insurance and process credit cards for VA accounts

·         Maintain or improve authorizations level based on trend and baseline measurements

·         Follow up with carriers and adjuster to determine best avenue in getting denials overturned.

·         Be able to explain the use of the current miscellaneous E1399 billing code Use strong influence skills with adjusters and case managers to obtain authorization as patient advocate and when there are measurable gains in                ROM and medical necessity

·         Manage and uphold Company policies for compliance and limits to recertification to prevent overutilization.

·         Maintain a pleasant phone manner with payors and be able to explain how t ERMI operates as well as the advantages of its use and how it differs from the competition.

·         If a payor requests additional information, that information is to be submitted to the payor within 24 hour 

·         If in the process of pre-authorization, an opportunity to contract arises, this lead should be passed to the Manager for follow-up.

·         Report any trends or abnormalities noticed in pre-authorization patterns to the Account Management Specialist Lead or Manager.

·         Process, and also Maintain database for department use and addend any and all specific authorization needs by payor, third party admin, or other, and according to State WC laws in order to optimize Authorizations for                    individual performance;

·         Train others in the department on WC changes by payor, third party admin, or other and according to State WC laws in order to optimize Authorizations for WC dept.