Patient Account Representative- Therapy Mgt

　　Department: Therapy Services - CPG1021

　　Entity: Champaign-Urbana Service Area

　　Job Category:

　　Employment Type: Full - Time

　　Job ID: 39749

　　Experience Required: 3 - 5 Years

　　Education Required: Not Indicated

　　Shift: Day

　　Location: Urbana, IL

　　Usual Schedule: Monday-Friday, 8:00a-5:00p

　　On Call Requirements: No

　　Work Location: Carle Urbana North Annex

　　Weekend Requirements: None

　　Holiday Requirements: None

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　　Position Summary:

　　Responsible for insurance authorizations, denials and appeals. Obtain updated compliance and regulatory requirements from companies, Medicare and IDPA. Work collaboratively with other departments such as patient accounts, registration and the coding department.

　　Qualifications:

　　EDUCATIONAL REQUIREMENTS None Required CERTIFICATION & LICENSURE REQUIREMENTS None Specified EXPERIENCE REQUIREMENTS Experience with billing, insurance companies and Medicare regulations. SKILLS AND KNOWLEDGE Excellent written and oral communication skills are necessary. PC skills are necessary, proficiency in Excel, Word and Access. Must enjoy troubleshooting processes, systems and developing solutions in detail oriented work environment. Must be able to work independently and have excellent phone etiquette.

　　Essential Functions:

　　Answers incoming calls from patients and works the patient's account to resolve any issues or refers to appropriate staff.

　　Assists patients and staff with billing and authorization issues.

　　Gathers evaluation, Plan of Care, and scanned documentation to fax to insurance carrier.

　　Helps to identify eligibility and insurance benefits.

　　Obtains prior insurance authorizations for Therapy Services.

　　Researches documentation to identify incorrect billing, does it become a write off or can we continue to bill with documentation modifications from the clinician.

　　Uses the EPIC system to gather information, and document authorization details.

　　Works with the coders to obtain a diagnosis code.

　　Keeps current on changes with insurance authorizations and cascades information to staff.

　　Manages work queues for timely authorizations and reauthorization for therapy patients.

　　Manages work queues to resolve errors for billing, stop bills and denials.

　　Works closely with internal and external case managers on workers compensation cases for therapy services regarding authorizations.

　　Identifies trends with denials and authorizations and communicates those to management team.

　　Reviews current process and assists with revision or development of new processes when insurance authorization requirements change.

　　We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: [email protected].

　　Effective September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members. Requests for medical or religious exemption will be permitted.