Responsible for accurate and timely pre-registration, submission of prior authorizations for SLPG Primary Care and Specialty practices, submission of insurance referrals for all Primary Care and Care Now departments, peer to peer evaluations, verification and validation of all financial information, and Point of Service cash collection for all services assigned to ensure proper reimbursement.
JOB DUTIES AND RESPONSIBILITIES:
R esponsible for the finan cial cle aran ce of all s ch eduled p ati ents by pro vi ding accu rate and timely v eri fic ation of all fin an cial info rmation and p recertifi cation/r efer ral f or all s ervi ces to ensure p rop er r eimburs ement.
Responsible for reviewing medical necessity of genetic testing/infusion services in addition to prior authorization to ensure revenue for services.
Monitors all hospital sch eduled diagnostic and surgical appointments to ensure that all cas es are id entified, and fin ancial clear ance is obtain ed.
Submit prior authorizations for all STAT imaging orders for PCP and Specialty prior to date of service.
Submit for insurance referrals for all PG Specialty and PCP orders and SL Care Now Departments.
Submit prior authorizations for diagnostic orders placed by PG PCP and Specialty service lines.
Utilizes specific Epic Work Queues designed for Prior Authorization and Insurance Referral workflows to ensure correct process is followed for proper documentation and billing in Epic.
Notifies all external providers of prior authorization requirements for scheduled services.
Notifies practices of all denied authorizations via in-basket message and provide peer to peer info for scheduling.
Review payer medical policies and contact the health plan’s UR department for first attempt appeal mitigation.
PHYSICAL AND SENSORY REQUIREMENTS:
Sitting up to ei ght (8) hours p er d ay, three (3) hours at a time. Consiste nt use of h ands and fin gers for typi ng, tel epho nes, d ata ent ry, etc. O ccasional t wisting and turni ng U ses upp er extr emiti es to lift and car ry up to 15 pounds. Stoops, b ends and r eaches above should er le vel to r etrieve files. He ari ng as it r elat es to no rmal con ver sation. S eeing as it relat es to gener al vision.
EDUCATION:
Hi gh sc hool gradu ate or equival ent.
TRAINING AND EXPERIENCE:
Three years healthcare experience in a department or office with a hospital, p hysici an’s o ffi ce, or simil ar medi cal f acili ty preferred. It is required to have at least one year in areas stated above. Strong custom er s ervi ce skills with kn owl ed ge of h ealth insur ances required. M ust h ave abili ty to w ork i nd ep end ent ly Comput er exp eri en ce r equ ir ed. Bilin gu al p refer red.
Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!
Founded in 1872, St. Luke’s University Health Network (SLUHN) is a fully integrated, regional, non-profit network of more than 23,000 employees providing services at 16 campuses and 350+ outpatient sites. With annual net revenue of $4 billion, the Network’s service area includes 11 counties in two states: Lehigh, Northampton, Berks, Bucks, Carbon, Montgomery, Monroe, Schuylkill and Luzerne counties in Pennsylvania and Warren and Hunterdon counties in New Jersey. St. Luke’s hospitals operate the largest network of trauma centers in Pennsylvania, with the Bethlehem Campus being home to St. Luke’s Children’s Hospital. Dedicated to advancing medical education, St. Luke’s is the preeminent teaching hospital in central-eastern Pennsylvania. In partnership with Temple University, the Network established the Lehigh Valley’s first and only four-year medical school campus. It also operates the nation’s longest continuously operating School of Nursing, established in 1884, and over 50 fully accredited graduate medical educational programs with more than 500 residents and fellows. In 2022, St. Luke’s, a member of the Children’s Hospital Association, opened the Lehigh Valley’s first and only free-standing facility dedicated entirely to kids. SLUHN is the only Lehigh Valley-based health care system to earn Medicare’s five-star ratings (the highest) for quality, efficiency and patient satisfaction. It is both a Leapfrog Group and Healthgrades Top Hospital and a Newsweek World’s Best Hospital. The Network’s flagship University Hospital has earned the 100 Top Major Teaching Hospital designation from Premier 13 times total and eleven years in a row, including in 2023 when it was identified as THE #4 TEACHING HOSPITAL IN THE COUNTRY.
