Job Description

Schedule: FT, Mon - Fri days (training on-site)

At Children’s, the region’s only full-service pediatric healthcare center, our people make us the very best for kids. Come cultivate your passion, purpose and professional development in an environment of excellence and inclusion, where team members are supported and deeply valued. Opportunities for career growth abound as we grow our services and spaces, including the cutting-edge Hubbard Center for Children. Join our highly engaged, caring team—and join us in providing brighter, healthier tomorrows for the children we serve. Children's is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.

A Brief Overview
Obtains essential information for insurance pre-certification requirements of anticipated care needs with third party payers on behalf of Children's Hospital & Medical Center related to Genetic and Complex Laboratory Testing. Works in collaboration with physicians, Genetic Counselors and other clinical staff to coordinate Genetic Testing for identified patients. Responsible to schedule and ensure proper ordering for multiple tests requested by ordering physicians. Communicates with patients, their families, physicians, Genetic Counselors and other clinical staff on as regular basis to insure appropriate and timely service.

Essential Functions

• Subject matter expert in prior authorization of Genetic and Complex Laboratory Testing. Coordinates scheduling process for patients receiving Genetic Testing. • Primarily responsible for coordinating the authorization for inpatient/outpatient genetic and complex laboratory testing • Identifies payment sources, verifies eligibility and patient liability based on plan detail. • Provides support to hospital staff for selection and order placement of genetic testing as needed. • Develops working relationships with genetic counselors and other clinical staff to obtain necessary information needed for the pre-authorization process • Researches genetic testing laboratories to provide assistance to physicians and other clinical staff when ordering genetic testing • Works with the Pathology Medical Director when questioning approved genetic testing laboratories. • Oversees resulted reports; scanning into EPIC when reports are not interface in the information system • Obtains consents for genetic testing and Advance Beneficiary Notices when needed
• Identifies payment sources and eligibility requirements • Works with access or other entities in the organization to obtain updated insurance information • Tracks follow-up dates according to initial authorization • Coordinates with referring/ordering physician when testing is denied by the third party payer • Coordinates with the billing department to related claim denials • Follows appropriate processes for appeals and peer to peer requests • Obtains and maintains knowledge of requirements for third party payers • Works as liaison between families, social work and patient advocates to help with payment plans or other forms of funding when necessary
• Provide information to laboratory billing team • Communicates patient information and the reference lab genetic testing will be sent to for charge entry purposed • Works with billing team on CPT code assignment and charge determination
• Collaborates with Information Technology analysts and the Laboratory Information System team to expand on resources • Test ordering for selection of appropriate tests • Test directory information • Expanding on-line tools and other resources for efficiency of authorization process
• Supports new staff, current staff, and students in Orientation, Training, and Competency
• Regular attendance at work is an essential function of the job.
• Perform physical requirements as described in the Physical Requirements section

Education Qualifications

• High School Diploma or G.E.D Required and
• Associate's Degree from an accredited college or university in a healthcare field Preferred

Experience Qualifications

• Minimum two years’ experience in authorizations, commercial/government billing and reimbursement processes or clinical medical office setting or clinical operations Required and
• Previous patient counseling experience Preferred

Children’s is the very best for kids and the very best for your career! At Children’s, we put YOU first so together, we can improve the life of every child!