STCI-AUTHORIZATION & CHARGE RECONCILIATION SPEC

General Purpose of Job:

Under the direction of the CV Authorization and Charge Reconciliation Supervisor, the Authorization and Charge Reconciliation Specialist's main objective is to ensure charge capture for professional charges for the CV Service for the ambulatory location. Responsibilities include obtaining insurance for orders placed by CV providers, verification of insurance, data entry of charges for services provided outside of EPIC, denial work queues, working as a liaison between referring physician caregivers and STCI to assist in ensuring appropriate authorization/medical necessity. In addition, the Authorization and Charge Reconciliation Specialist will work in collaboration with CV ambulatory clerical team to facilitate scheduling and patient access for CV services.

Essential Duties:

This job description is intended to cover the minimum essential duties assigned on a regular basis. Caregivers may be asked to perform additional duties as assigned by their leader. Leadership has the right to alter or modify the duties of the position.

• Charge entry for services provided at non-Sparrow facilities and/or services performed outside of EPIC.
• Collect complete and accurate confidential demographic and financial information to comply with regulatory agencies and authorization requirements.
• Direct communication with patient as necessary to ensure appropriate insurance information for charge capture.
• Efficiently work CV Service work queues including but not limited to insurance authorization, claim edit, medical necessity denials and MSPQ.
• Work as a liaison to assist providers with appropriate ICD-10 for charge compliance purposes at the point of diagnostic ordering.
• Verify insurance eligibility and covered benefits by using all electronic systems available or by phone.
• Collect and verify necessary insurance authorizations as appropriate and possess knowledge of financial class requirements regarding registration and insurance requirements.
• Operate multiple computer applications to register patients, and retrieve surgical, testing, insurance and financial information.
• Communicate with providers (physicians, APPs, RNs) regarding orders placed for patients.
• Serve as a liaison between STCI Cardiology Lansing Clinic and other departments e.g. Patient Support Services, Patient Access, SMG Referring physician offices and Billing Department in order to obtain required data for charge capture.
• Work exception accounts held internally or rejected by payers for errors related to registration and financial clearance activities.
• Work as liaison to resolve authorization questions or other with payers as necessary.
• Continued medical billing education to remain current with payer changes.
• Provide education to CV Clerical Team regarding payer changes.