Schedule: Full-time, 8:30am to 5:00pm, Monday-Friday
Location: Boys Town National Research Hospital - Central Billing Office at S. 42nd St.
In a career at Boys Town National Research Hospital, you join us in changing the way America cares for children and families. We are currently expanding services. Come grow with us!
Under the supervision of the Surgery Verification Supervisor and Manager of Coding & Surgery Verification, is responsible for pre-registration of hospital surgical and ancillary services. Primary functions include: insurance eligibility verification, benefit and out of pocket liability determinations, pre-determination and pre-certification / authorization of surgeries and/or other clinical services performed at BTNRH, or on behalf of a BTNRH provider. Responsible also for communicating benefits and liabilities to patients while working to set up reasonable payment accommodations or collecting in advance of services rendered and referring to Patient Financial Counseling services when necessary.
Maintains excellent communication and positive rapport with all points of contact both internally and externally, documenting pertinent discussions and details of correspondence in all applicable systems to provide tracking and point of reference.
Responsible for obtaining and communicating accurate benefit information and eligibility, pre-determination/pre-authorization as well as detailed benefit and patient liabilities per insurance company requirements and established timeframes, i.e., online vs. telephone to ensure credible coverage and benefits are in place.
Responsible for monitoring incoming additions, revisions and cancellations as well as clinical requests for authorization and benefit identification. Practice includes; printing scheduled procedures from the Surgery Information System, assigning self to work case and identifying any need to contact patient to obtain additional registration or demographic information, as well as determining any change to authorization and/or coverage requirements.
Routinely monitors cases pending or not yet started/complete which are a minimum of 1 month (4 weeks) out from scheduled date of service and initiates authorization/determination/eligibility process being attentive to payer specific processing time frames or clinical documentation needs.
Obtains the necessary CPT, HCPC and Diagnosis codes as needed through utilization of coding resource materials, or through Supervisor or Coding Department assistance. When Codes are provided through community Provider office, will validate agreement of codes through internal practice and work with servicing provider to address any variance in findings.
Initiates expedited reviews with payers when necessary to ensure authorization is in place prior to, or at the time of service and communicates late notifications or risk of no auth situations to Supervisor as soon as identified.
Identifies and takes steps to ascertain and provide necessary clinical documentation to meet payer requests as needed for authorization or pre-determination needs.
Responsible for data entry of documentation on patient accounts in the computer system, including completion of a surgery admission packet, financial disclosure and necessary admission forms.
Communicates in a positive and professional manner with the patient / guarantor on any financial issues, including assisting with Financial Assistance application or referrals, accepting of required down payments and setting up acceptable payment plan agreements.
Meets productivity and quality standards, following all documentation guidelines as communicated by leadership.
Other Duties: This job description incorporates the essential functions and duties required for this position. However, other duties may be required and assigned at times and as determined by a supervisor in order to meet the needs of the organization.
Knowledge, Skills and Abilities Required:
Knowledge of insurance terms, reimbursement procedures, rates and policies related to medical terminology.
Ability to give attention to detail and follow established standards and procedures.
Knowledge of Explanation of Benefits (EOB), CPT, HCPC and Diagnosis Codes.
Must have excellent verbal/ written communication skills to communicate effectively with physicians, patients and families.
Knowledge of telephone etiquette required.
Ability to handle multiple tasks at a time.
High school diploma or equivalent.
Minimum of 2 years' experience working in a hospital or clinic billing environment, preferably focused on registration, billing and/or preauthorization, preferred.
Knowledge of insurance terms and reimbursement procedures.
Must be detail oriented.
Knowledge of Explanation of Benefits (EOB).
Excellent verbal and written communication skills required.
Excellent telephone etiquette.
About Boys Town National Research Hospital:
Since the opening of Boys Town National Research Hospital in 1977, the hospital has been internationally recognized as a leader in clinical and research programs focusing on childhood deafness, visual impairment and related communication disorders. The hospital annually serves more than 44,000 children and families from across the United States. With 28 research labs and $7.1 million annually in extramural funding, the Boys Town National Research Hospital is dedicated to providing leading edge clinical care, pioneering translational research, and improving the lives of children and their families through applied technology and educational outreach programs.
Our employees are our #1 supporters when it comes to achieving Boys Town's mission, which is why we offer an array of competitive and attractive benefit options. Unique perks to Boys Town employees and their families include free visits to Boys Town Physicians, free prescriptions, tuition assistance, access to the campus Field House, parenting resources from our experts and advancement opportunities within the organization, just to name a few. Working at Boys Town is more than just a job, it is a way of life.
Date Posted: January 30, 2020
Job ID: 15072
This advertisement describes the general nature of work to be performed and does not include an exhaustive list of all duties, skills, or abilities required. Boys Town is an equal employment opportunity employer and participates in the E-Verify program. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. To request a disability-related accommodation in the application process, contact us at 1-877-639-6003.
Internal Number: 15072
About Boys Town National Research Hospital
Since the opening of Boys Town National Research Hospital in 1977, the hospital has been internationally recognized as a leader in clinical and research programs focusing on childhood deafness, visual impairment and related communication disorders. We have developed national medical programs that are now instituted in hospitals and clinics across the country.
Today, the hospital offers a broad range of clinical services, including ear, nose and throat services at the Boys Town Ear, Nose and Throat Institute, general pediatric care with Boys Town Pediatrics, and orthopaedic, internal medicine, pediatric gastroenterology, allergy, asthma, pediatric pulmonology, behavioral health, audiological and ophthalmologic care.
The hospital has expanded to offer surgical and clinical services at two Omaha locations: 555 North 30th Street in Omaha and 14000 Hospital Road on the campus of Boys Town, Nebraska.
Boys Town National Research Hospital has assembled national leaders in research who are making important contributions in the areas of genetics, hearing, language, vision and speech disorders. Applying these findings with new technologies, distance learning and the exploration of ne...w research frontiers, the opportunities for new medical diagnoses, evaluation and treatment discoveries are endless.
Accredited by The Joint Commission, Boys Town National Research Hospital is dedicated to providing leading edge clinical care, pioneering translational research and improving the lives of children and their families through applied technology and educational outreach programs. The hospital annually serves more than 40,000 children and families from across the United States.