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Summary

Fri May 11, 2018 - 19 weeks ago

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Insurance & Patient Account Specialist

Insurance & Patient Account Specialist


Requisition #

44354BR



Physical Location

Minneapolis, Minnesota



Posted Date

09-May-2018



Dept. Name

Business Operations Admin



Hours Per Week

40



Contract

Noncontract




Introduction


Allina Health is dedicated to the prevention and treatment of illness and enhancing the greater health of individuals, families and communities throughout Minnesota and western Wisconsin. A not-for-profit health care system, Allina Health cares for patients from beginning to end-of-life through its 90+ clinics, 12 hospitals, 16 pharmacies, specialty care centers and specialty medical services that provide home care, senior transitions, hospice care, home oxygen and medical equipment, and emergency medical transportation services. Allina Health is a vibrant, growing organization with opportunities to suit your professional skills and a diverse work environment to match your specific interests. We believe employees are our greatest asset and are dedicated to helping you develop and maximize your professional skills.


Allina Health clinics are committed to providing a work environment where passionate people have the knowledge, tools, opportunity and freedom to make a positive difference in the lives of our patients. We want you to be part of our team where each employee contributes to our mission of exceptional primary and specialty care. Allina Health clinics provide primary care, specialty care and urgent care services to people in 41 communities. More than 750 health care practitioners help patients identify health risks, manage chronic illness and find their path to better health.




Responsibilities


Req ID: 44354

+ Completes all necessary work to resolve pre and post claim errors thus ensuring payment from commercial & government payers

+ Accurately enters and verifies registration/insurance information (including benefits) by utilizing all resources available to take action including electronic query and/or calling the insurance company

+ Resolves accounts in the work queues resulting from inadequate claim field data, incorrect data in fields, or non-populated required data fields to allow billing of the service on a claim.

+ Resolves denied claims.

+ Prioritizes and completes work effectively and efficiently maintaining quality and production standards

+ Communicates with payors, clinics or patients through messaging and phones

+ Obtains prior authorization and/or pre-certification (medical necessity) for medical services (surgeries, procedures, imaging, clinic based injections and infusions, hearing aids, sleep studies, etc) according to the health plans.

+ Researches and documents coverage determination requests for prior authorization (PA) by independently researching the EMR chart notes and historical clinical data to identify prior therapies and treatments.

+ Identifies insurance treatment requirements and reviews the medical record to assure the insurance requirements are met for prior authorization approval.

+ Applies clinical knowledge when assessing and responding with alternatives to denied prior authorizations

+ Reviews clinical documentation in the Electronic Medical Record and preps findings and research for providers when further clinical clarification is needed in the prior-authorization process to meet insurer contractual requirements and optimize patient outcomes

+ Packages and provides alternate options to the provider when an authorization is denied. This may include research for quantity limits, step therapy, formulary and tier research exceptions.



+ Schedules ambulatory consult orders according to Allina Health guidelines


+ Performs other duties as assigned





Education



+ A high school or GED minimum


+ Two-year degree preferred





Qualification/Skills



+ Minimum of 1 yr experience in revenue cycle, including experience in performing insurance verification in an Electronic Medical Record (e.g. Epic) system.


+ Preferred experience utilizing insurance verification tools such as Healthia/EEVE.


+ Preferred experience in working work queues (insurance and/or clinic billing work queues)


+ Strong experience in customer service.


+ Strong attention to details.


+ Able to work in production environment with quality standards.





Work Schedule



+ 40 hours per week


+ Monday - Friday


+ Current available hours:


+ 7:00 AM - 3:30 PM


+ 8:30 AM - 5:00 PM




+ Benefit Eligible


+ No weekends


+ Non-contract





Location/Community Information


Minneapolis boasts being both cosmopolitan yet small enough that you can find a place to call home whether on a lake, golf course, or in an adjoining suburb. With the fast pace of activity there are professional sports, theater, or enough parks for a quiet walk. The area has numerous schools and colleges, both public or private, and enough teams for all weekend athletes to join.




+ Located in Minneapolis



+ Population = 380,000



+ Service Area = 2,882,245



Community Resource Links:


Community Information School Digger


Explore Minnesota MN Dept of Education


Minneapolis St. Paul MagazineSt. Paul Pioneer Press


Twin Cities Living MagazineStar Tribune




Closing


If you are interested in becoming part of our award winning team of professionals, please apply online today. Allina Health is committed to providing Equal Employment Opportunities to all employees and applicants. EO M/F/Disability/Vet Employer.





Requisition #

44354BR


Administrative



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