Preclaim Data Coordinator I (Temporary)

1 month ago
Job ID
2017-5121
US
Category
Commercial Operations
CA
Redwood City

Overview

Billing & Reimbursement: Clinical criteria and pre-claim documentation preparation to help facilitate internal payer claim support activities.  Correlate order intake detail to complete Patient insurance verifications and benefit inquiries.  Determine appropriate Prior auth, Pre-claim and other reimbursement related requirements for Oncotype assay orders. Communicate with internal cross functional related groups and external parties for enhanced order to claim workflow.

Responsibilities

  • Maintain ongoing tracking and appropriate documentation on referrals
  • Ensure complete and accurate patient demographic and insurance information. 
  • Assemble patient's clinical case info and determine referral needs, based on payer guidelines, and Identify missing clinical information. 
  • Create case communication to ensure prior approval requirements are met.
  • Facilitate process flow for necessary medical information, provide specific follow up to and directions on     completing pre-claim activities to support reimbursement and improve clean claim initiatives
  • Be the systems navigator and point of contact for the internal management team to ensure approvals communication of the necessary services for the patient case in a timely fashion.

Qualifications

  • 2-4 years’ service billing/collections experience within the provider setting
  • Knowledge of and/or experience with public & private Managed Care payers and claims reimbursement process
  • Effective communication skills, both written and oral across internal and external personnel –
  • Collaborative and works effectively as a team member
  • Strong attention to detail and organizational skills
  • Knowledge claims EDI and coding is a plus
  • Good judgement and problem-solving skills
  • Able to take and follow through with delegated tasks and accountability

Travel, Physical/Mental Demands and Work Environment

- Standing or sitting for long periods of time may be necessary
- Some lifting (greater than 25 pounds) may be necessary; Facilities, Materials and Engineering employees occasionally must lift at least 50-75 pounds.

Options

Sorry the Share function is not working properly at this moment. Please refresh the page and try again later.
Share on your newsfeed