Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.
Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?
This position is responsible for obtaining pre-certification. The employee will ensure access to integrated health care; achieve clinically appropriate authorization to assure optimal reimbursement for the hospital for services provided. The position will ensure financial security of Infusion services, including verification of benefits, ensuring medical necessity coverage, order compliance, and obtaining needed precertification's. The role also includes charge entry for infusion services performed.
- Demonstrates professionalism and sensitivity in all patient/caregiver interactions. Observes and proactively acts to give directions, to answer questions or to provide information or reassurance regarding billing and financial matters as necessary.
- Review chemo schedule in advance and determines patients insurance requirements for pre-cert, coverage limitation and determine necessary action prior to patient arrival.
- Provide required clinical and demographic information to payer to obtain precertification and assure reimbursement
- Interact with medical staff and their designees to obtain complete, accurate, timely clinical and financial information required for payer reimbursement.
- Verifies insurance eligibility and insurance data to determine coverage and benefits for services being performed. Obtains and verifies prior authorization and referrals for services being performed, documenting the prior authorization/referral information in EPIC. Obtain authorizations from carriers for infusion services. Confirm that the required precert/authorization information is correctly listed in EPIC.
- Conducts screening of the diagnosis and infusion requested to determine if the diagnosis supports the medical necessity. When necessary, secures a physician’s order/script or updates to physician’s order script, with ICD10 Codes and/or a narrative diagnosis, procedure, and physician’s signature to support the medical necessity of testing being performed.
- Enter and reconcile daily infusion charges into EPIC
- Performs duties in accordance with Penn Medicine and entity values, policies, and procedures
- Keeps manager aware of potential issues / problems as they arise
- Ability to solve billing problems and knowledge of medical terminology
- Other duties as assigned to support the department, entity, and health system organization
Education or Equivalent Experience:
- Associate of Arts or Science
- Some college related to healthcare, business or human services. Experience related to Healthcare, business or human services.
- H.S. Diploma/GED (Required)
- 4+ years responsible positions in physician billing operations and accounts receivable management. Specific knowledge of precertification requirements, CMS medical necessity requirements, third party billing processing procedures is ideal. Experience in the insurance industry or in an academic medical center highly preferred, as well as general knowledge of insurance company procedures and the dynamics of health care systems. Related to healthcare, business, or human services
We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.
Live Your Life's Work
We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.