Location: Melville,NY, USA
Overview Catholic Health is one of Long Islands finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes to every patient, every time. We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace! Job Details The Appeals and Authorization representative will perform activities to resolve authorization denials for ambulatory practices, and facilitate appeals for hospital based services. SPECIFIC RESPONSIBILITIES AND DUTIES Review all authorization denials entered into the EPIC billing system. Update any authorizations that were either not on the claim or had invalid values and resubmit. Compile spreadsheets for each practice of all denials that have been confirmed as correct with no additional information available in scanned documents. Send out collaborative emails to the practices detailing total denials and status on appeals. Prepare appeals for claims the practices provide additional authorization information on. Prepare appeals for hospital based services denied for no authorization. Provide insight on enrollment issues that are contributing to authorization denials. Track all data sent to practices and maintain a schedule for communications. Notifies Department Leadership of potential missed timeframes for submission and follow-up on responses and escalates cases as appropriate. Serves as a liaison between patient account services, physician practices. At times this may require meetings with office staff to review specific issues related to authorization denials. Review workflows related to authorization and appeals for opportunity to improve. Review workflows for denial reduction and appeal prevention. Provides support for ongoing projects as required Meets productivity standards. Attends meetings as required and participates on committees as directed. Performs other related duties as assigned or requested. POSITION REQUIREMENTS AND QUALIFICATIONS Education/Experience Knowledge of CPT and ICD 10 coding with excellent written skills Knowledge of third party payer requirements for authorization for in and out of network payers. Knowledge of appeals process for in and out of network payers. Coding Certification preferred (not required) Minimum of 3 years Healthcare experience SKILLS Sound knowledge and skill in the use of personal computer and software for word processing, spreadsheet and database applications required. Ability to effectively communicate with all levels of staff in a verbal and written manner; demonstrated ability to be organized and efficient in prioritizing and managing assignments with minimal oversight and direction. Demonstrates a courteous and professional demeanor, team spirit and the ability to work in a collaborative, effective manner. Ability to utilize critical thinking and apply sound clinical judgment and assessment skills for decision-making. KNOWLEDGE Maintains knowledge of requirements by third party payers, regulatory agencies, and managed care entities concerning levels of care, continuity of benefits and medical necessity guidelines. Knowledge of managed care and the current standards and trends of patient care, best practices, management tools. Technical Requirements: Must have high speed Wi-Fi. Must meet technical access requirements for remote efficiency Hybrid requirements: Hours must be worked during standard business hours 8-4, 9-5 *hrs. may vary when covering at office Must meet all productivity standards Must attend all required meetings remotely and in person as required Responsible to ensure the safety and condition of all CHS provided hardware Must have private secured workplace. Salary Range USD $27.00 - USD $32.00 /Hr. This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidates qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits. At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.