Health Plan Coordinator; Rehab

Pay Range: $22.64/hr. to $31.22/hr.

Responsible for implementing and coordinating procedures and functions related to patient admission, billing, and insurance authorization in the Outpatient Rehabilitation Services Departments.

Performed majority of the time:

• Maintains tracking and follow-through of forms for commercial, workers compensation and MVA for Physical Therapy, Occupational Therapy and Speech Language Pathology.
• Obtains prior authorization for insurances that require prior to services rendered.
• Schedules patients accordingly to insurance authorization and therapist recommendations.
• Acts as a back-up for receptionists (scheduling, answering and routing incoming phone calls, providing scheduling guidance to CARS staff.)
• Provides daily reporting via Box document (ambulatory clinics.)
• Monitors rehab work queue (clinic appropriate) in EPIC and checks for insurance follow up and authorization submission.
• Monitors and tracks insurance authorizations via specific insurance excel documents in Box (i.e. Workers Comp, Medicaid, Evicore…etc.)
• Verifies insurance benefits and eligibility for all new patients prior to treatment.
• Monitors, tracks and calculates Medicare therapy cap.
• Reviews following day rehab schedule to ensure that all scheduled appointments have a valid therapy referral attached to the patient appointment.
• Verifies completion of referral process for patient with insurance plans requiring referral by PCP prior to services.
• Copies workers compensation chart notes and forwards to workers compensation adjuster(s) within 7 days of the evaluation/ progress note.
• Creates and maintains PT/OT/SLP charts.
• Requests chart notes or diagnostic reports from referring doctors before patient’s appointment as indicated per referral.
• Stays abreast of insurance updates/changes (attends webinars, meetings and receives e-mail updates.)
• Communicates with therapists regarding prior authorization workflow process and when to submit for more authorization.
• Communicates with referring MD office to submit prior authorization to insurance when required for therapy prior to the therapy appointment.
• Communicates with Patient Accounting to submit notification to insurance for start of therapy.
• Communicates with Patient Accounting when to re-bill for therapy visits.
• Submits retro authorization requests to insurances where appropriate.
• Submits insurance appeal correspondence to Patient Accounting where appropriate.
• Opening reception duties which include: preparing copay collection envelope / locked money bag for courier pick up, unlocking clinic front door, turning on lights in gym and front office, checking voicemail messages.
• Updates therapists scheduling templates.

Performed occasionally but critical to successful performance of the job:

• Attends monthly full clinic/staff meeting.
• Participates in quality improvement for increasing patient satisfaction with department services.

Education:

Required

• N/A

Preferred

• Associate degree in Business or related field.

Experience:

Required

• N/A

Preferred

• Two (2) years’ experience in medical office or insurance billing.

Licenses, Certifications and/or Registrations:

Required

• N/A

Preferred

• N/A

Job Related Skills, Abilities and Behaviors:

Required

• Professional appearance and personal conduct for the employee's particular job.
• Uses effective communication skills taking into consideration body language, filters, listening, paraphrasing, and questions with customers of diverse ethnic and cultural backgrounds.
• Excellent customer service and interpersonal skills.
• Ability to work independently with efficiency and confidence.
• Excellent telephone, written and verbal communication skills.
• Experience in working with multiple tasks with many interruptions.
• Organization…