1. Serves as principal source of information on rules and procedures governing University accounts receivable that may vary by payor, procedure code, service line and specialty. 2. Communicate with insurance companies to obtain information relevant to getting an authorization/referral. 3. Review patient's medical chart in order to provide appropriate office notes, surgical records, diagnostics and any relevant documentation in order to obtain authorizations and/or referrals. 4. Responsible for preparing pre-determination cases for insurance company review and approval of complex cases, which will include printing photographs, reviewing medical documentation, including but not limited to imaging, pathology, outside medical records, physical therapy notes and primary care physician records for providers not utilizing EPIC. 5. Assists with training and instruction to support staff. 6. Recommends and implements changes to systems and operating procedures. 7. Verify patient's insurance coverage. 8. Interact with internal/external contacts such as various departments within YMG including but not limited to the clinical, reimbursement and billing departments to research and resolve problem accounts. 9. Assist departments with questions and issues relating to the authorizations/referrals. 10. Ability to work independently and meet specific timelines. 11. Follow-up on pending authorizations/referrals and document accordingly. 12. Assist in the development and continued implementation of department policies and procedures. 13. Responsible for answering the authorization/referral line. 14. Perform clerical functions incidental to account activity. 15. Communicate back to departments/providers on denied services and peer to peer reviews and next steps. 16. May perform other duties as assigned.
Preferred Education: Ability to speak Spanish preferred. Knowledge of EPIC system. Working knowledge of medical insurance authorizations and referrals preferred.
Preferred Education, Experience and Skills: Ability to speak Spanish preferred. Knowledge of EPIC system. Working knowledge of medical insurance authorizations and referrals preferred.
Required Skill/ability 5: Demonstrated record of excellent attendance, punctuality and time management. Professional demeanor and attire.
Posting Position Title: Account Assistant 4, YM Precert, Auth & Referral
Required Skill/ability 3: Proven ability in providing superior customer service, including the ability to handle heavy telephone communication with patients, providers, insurance carriers, etc. in a professional, courteous and tactful manner.
Work Week: Standard (M-F equal number of hours per day)
University Job Title: Account Assistant 4, YMA
Required Skill/ability 1: Demonstrated ability using computerized database systems and Microsoft Office Suite (especially Word and Excel). Ability to learn and adapt to new software applications.
Required Skill/ability 4: Strong written and verbal communication skills. Team-oriented, flexible and ability to work with changing priorities and work flows. Ability to multi-task, problem-solve and prioritize. Good attention to detail.
Required Skill/ability 2: Ability to handle challenging/complicated situations professionally.
Four years of related work experience, two of them in the same job family at the next lower level and a high school level education; or two years of related work experience and an Associate's degree; or an equivalent combination of experience and education.
Internal Number: 53210BR
About Yale University
Yale University is an American private Ivy League research university located in New Haven, Connecticut. Founded in 1701 in the Colony of Connecticut, the university is the third-oldest institution of higher education in the United States.