Reports To: Revenue Cycle Director
FLSA Classification: Full-Time, Non Exempt, Hourly $19.51 -$23.51
Essential Functions:
- Obtains pre-authorizations for imaging.
- Reviews information regarding insurance eligibility, deductibles, coinsurance, and/or copays for patients.
- Informs patients of their financial responsibility either via phone or mail.
- Works closely with clinical team to obtain various clinical documents to complete the pre-authorization process.
- Submits requests via insurance portal, fax, or phone.
- Communicates denials to appropriate provider or department.
- Completes requests accurately and timely to ensure quality patient care.
- Understands the Athena/Meditech Authorization Management tool and is able to troubleshoot issues.
- Will cross-train extensively in the areas of hospital and clinic registration and discharge.
- May be required to obtain pre-certification information on hospital and swing bed admits.
- May be required to review and complete Emergency Department registrations.
- Documents appropriate information on accounts on which action has taken place.
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
- Conducts self in accordance with PMC’s employee manual.
- Makes suggestions and helps with continuous quality improvement in all department processes.
- Maintains up-to-date guidelines to ensure responsibilities of the essential job functions are adequately outlined for training purposes. Manuals are to be easily identified and readily available.
- Participates in educational activities, staff meetings, and in-services as required
- Other duties as assigned.
Education and Experience:
- High school diploma or equivalent required.
- Revenue Cycle courses and continuing education as provided.
- Annual Medicare Fraud and Abuse Education.
- Medicate Secondary Payer documentation.
- Certification as a Revenue Cycle Specialist through the American Association of Healthcare Administration Management (AAHAM) or certification as a Certified Revenue Cycle Representative (CRCR) through Healthcare Financial Management Association (HFMA) is desired within two (2) years of employment.
- Current BLS required within six (6) months of transfer or hire.
- Knowledge of medical billing practices, including ICD-1-, CPT, and HCPCS codes desired.
Skills and Expectations:
- Kind and professional demeanor.
- Professional and well-groomed appearance at all times.
- Communicate positively and effectively, both written and verbally, with patients, family, and staff.
- Demonstrate effective organizational skills in an evolving environment.
- Work with honesty, compassion and integrity at all times.
- Understand and adhere to the scope of service for the department and this position.
- Understand and adhere to all of PMC’s policies and procedures.
- Understand and adhere to PMC’s Code of Conduct.
- Adhere to the strictest confidentiality and HIPAA regulations.
- Demonstrate a commitment to building and sustaining a diverse, inclusive, and equitable working environment.
- Ability to remain calm and efficient in emergency situations.
- Demonstrate strong problem-solving skills.
- Demonstrate strong emotional intelligence.
Physical Requirements:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing this job, the employee:
- Must be able to remain in a stationary position 50% of the time.
- Must be able to move and traverse about the facility 50% of the time.
- Frequently transport objects weighing up to 50lbs
- Occasionally position objects weighing up to 100lbs.
- Must be able to communicate and exchange information in a way others will understand.
- Must be able to recognize details such as color and depth within a few feet of the observer.
- Frequently operates computers, machinery, and other healthcare equipment.
- Constantly positions self to complete essential functions.
- May be required to wear N95s or PAPRs throughout the shift.
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice
Pioneers' history began in 1947 when Freeman Fairfield, a previous resident of this community, approached the County Commissioners about establishing a hospital. Over the next several years, Mr. Fairfield worked with the Commissioners and a group of local citizens to build a hospital for the Meeker community. Opening its doors in 1950, Pioneers began offering acute health care and surgical services to the community, licensed through the State of Colorado Department of Health and Human Services. We are Medicare and Medicaid-certified, accept private insurance, and, of course, self-pay. Financial arrangements may be set up through the Business Office.
In 1964, the Walbridge Memorial Convalescent Wing opened its doors for long-term care, made possible through the generosity of the wills of Carl and Adelaide Walbridge. Attached to the north side of the hospital, the Wing, with its 33 beds, brings skilled and intermediate nursing to residents who are unable to care for themselves. Through the Wing's rehabilitation services, exercise, and activity groups, each resident's care is individualized to meet his or her physical, emotional, nutritional, and spiritual needs. The Wing is licensed by the State of Colorado Department of Health and Human Services, and accepts Medicare, Medicaid, and private-pay residents.
First-line health care services are delivered through Meeker Family Health Center. The MFHC originated in 1990 as a rural health clinic, and its physicians, nurse practitioners, and staff continue to strive to meet our community's and visitors' healthcare needs.
