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Administrative/Clerical
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2018-R0184095 Requisition #
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Job Type: Part Time
Scheduled Hours per 2 Week Pay Period: 48
Daily Schedule: 9AM-3PM
Weekends Required: None
Location: Bremerton,WA

 

CHI Franciscan Health has exciting and rewarding careers with competitive salaries and benefits.  We are a family of hospitals, health care services, and medical providers delivering compassionate care to people throughout the South Puget Sound. We are part of Catholic Health Initiatives, one of the largest not-for-profit health care systems in the country.
Our mission is to deliver high quality care that meets our patients' medical needs while providing emotional and spiritual support to patients and their families. We believe this three-part approach — physical, emotional, and spiritual — is essential to healing the whole person. Come join our team!

Job Summary:

This job is responsible for verifying the patient’s insurance information and obtaining pre-authorizations for medication approvals prior to scheduled outpatient appointments in accordance with HIPAA guidelines, internal standards and procedures, and other regulatory requirements.  An incumbent contacts physician’s office and or obtains pertinent information from epic to obtain documentation according to the specific requirements of the applicable insurance company.

Work includes:

1) Verifying insurance coverage, particularly with respect to specific medications;

2) Working with Conifer in scheduling patient appointments and assisting billing in resolving denials to facilitate payment;

3) Researching potential resources to help patients with uncovered medication needs;

4) Keeping abreast of changing market conditions and which medications require insurance company pre-authorization

5) Tracking drug/medication availability to meet patient needs

 
Essential Duties:

Receives physician referrals and/or monitors referral work queue.  Connects with pharmacy for initiating therapy plan, begins process to validate insurance coverage and obtain pre-authorization for specific drugs/medications. 
 
Researches and/or contacts local/national service organizations and drug companies to identify potential resources available to provide assistance to patients with the high cost of needed drugs/medication.

Serves as liaison with Conifer in scheduling patient appointments; works with the Billing Dept. to research, address and prevent insurance denials. 

Serves as liaison and establishes/maintains effective relationships with insurance companies, physician’s offices and other stakeholders; maintains current knowledge of internal, industry and regulatory requirements applicable to assigned function.

Documents all activities and findings in accordance with established policies and procedures; ensures the integrity of all account documentation; maintains confidentiality of medical records.
 

Additional Responsibilities:

Work requires knowledge of insurance pre-authorization/billing and privacy/confidentiality practices, as well as knowledge of medical terminology and insurance payor (specifically Medicaid) requirements.

An incumbent follows proper channels of communication in handling routine problems and recognizing issues that need escalation to management.

Strong customer service skills and the ability to produce work with a high degree of accuracy/timeliness while meeting productivity standards are also required.
Ability and willingness to acquire the general coding for the different diagnoses and medications.
Adheres to and exhibits our Core Values of Reverence, Integrity, Compassion and Excellence. 

 

Education/Work Experience Requirements:

Two years of related work experience that demonstrates attainment of the requisite job knowledge and abilities. 

Experience in a clinical setting working with insurance companies and/or physician's office for authorization.

 

About Us


Chances are, you’re here because you’re looking for a career offering greater opportunity, challenge and fulfillment. We’re confident you’ll find all three at CHI. As one of the nation’s largest nonprofit health systems, we offer a wealth of careers across more than 101 hospitals in 18 states. Our faith-based health system welcomes you to share in our mission of building healthier communities, whether as a surgeon in the operating room or an administrator in a conference room. When you work in a supportive environment with like-minded professionals, wonderful things happen. Learn More

Equal Opportunity Employment


Consistent with our Core Values, Catholic Health Initiatives employers are EEO/AA/M/F/Vets/Disabled Employers. Qualified applications will receive consideration for employement without regard to their race, color, religion, national origin, sex, sexual orientation, gender identification, protected veteran status, disabilitiy or any other legally protected characteristic. 

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