Under general supervision is responsible for contacting third party payers and obtaining authorizations/referrals for specialty physicians for all diagnostic testing and in-patient/out-patient surgical procedures. Interprets Managed Care contracts and other third party payer contacts in order to secure correct authorization and/or referral. Assures authorizations/referrals and re-authorizations are obtained and secured for patients. Obtains appropriate clinical data for admission and out-patient surgery. Verifies eligibility and benefits of patient plans to assure proper processing of referrals. Informs patients of delays due to eligibility or benefit issue within forty-eight hours. Educates patients, staff and physicians on latest insurance requirements with respect to the referral process. Uses CPT and ICD-9 codes for diagnosis and procedures accurately. Boards all surgeries at appropriate facility. Provides patients with date of procedure, when and where to report, and assures that all specialty clearances are obtained. Prepares tentative schedule for operating room twenty-four hours in advance, works with surgical department to ensure appropriate equipment is available for procedure. Compiles statistics and other required data. Confirms and reschedules patient appointments as necessary. Notifies manager with patient accounting or insurance issues as necessary. Collaborates with the Perioperative Institute regarding testing necessary to gain clearance as well as keeps open communication regarding all patient issues with the PI and their staff. Attends mandatory training programs. May perform functions related to business activities including, but not limited to, patient appointments, registration, medical record management, cash collections, phone communications and office maintenance. Actively participates as a team member, including mentoring new employees. Performs other related duties as assigned.
1. High School diploma or equivalent. Associate's degree in Finance, Business Administration or related field preferred.
2. Two to three years of medical billing, medical records and insurance referral process experience.
3. Working knowledge of medical terminology.
4. Advanced knowledge of third party payer's requirements and reimbursement.
5. Working knowledge of Michigan based Managed Care programs.
Primary Location: Detroit, Michigan
Facility: DMC Receiving Hospital
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 2105004770
About DMC Receiving Hospital
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.