At Cincinnati Children's, we believe in nurturing employees' lives as well as their careers. Our benefits equal or surpass other hospitals in the region, and we're proud to offer one of the best working environments in our field to include opportunities to advance your career within our organization. Our benefits help you manage your health, protect you if you are unable to work, help you further your education, and prepare for retirement.
In this role you would be responsible forAuthorization Denial Management. Working collaboratively with Divisions and Insurance Payors to overturn and appeal Outpatient Authorization denials, as well as working with the front end to help to prevent initial denials. Identifying trends and best practices for resolving denials and eliminating write offs.
Prepares and forwards patient claims to appropriate third-party payers. Analyzes and reviews claims to ensure that payer-specific billing requirements are met. Follows up on billing, determines and applies appropriate adjustments, answers inquiries and updates accounts as necessary.
Compile and prepare patient charges. Prepare invoices billings, UB-04 and 1500 claim forms to be sent to 3rd party payers for payment indicating individual line items for services and total costs.
Review charges. Obtain and evaluate family, third party payers and agency resources for payment of charges.
Managing patient billing and ensure procedures are billed according to contracts, transmit or mail all paper and claims, and review correspondence and follow up as needed.
May perform duties of FSR I & II. May have specialized areas of responsibility (e.g. government & non-government billing, appeal processing, review & approval of refunds, etc.).
Identify system and technology needs.
Participate in advancing use of technology.
Ensures systems meet all regulatory and compliance requirements.
Act as a preceptor and/or lead for new employees.
Perform specialty services functions. Act as a resource within the department/division.
Provide instruction for performing non-routine functions.
Serve as a liaison between Physicians Billing Service, Admitting, Outpatient Surgery, Outpatient Department, Patent Financial Services and other Cincinnati Children's departments.
May have supervisory responsibilities.
May perform research and analysis. Participate in departmental/division performance improvement and quality assurance controls.
May develop and execute corrective actions plans.
High school diploma or equivalent
3 - 5 years of work experience in a related job discipline (denial experience, appeals, expected reimbursement experience and must be familiar with contracts)
At Cincinnati Children’s, we come to work with one goal: to make children’s health better. We believe in a team approach, both in caring for patients and their families, and in advancing science and discovery. We strive to do better, and find energy and inspiration in our shared purpose. If you want to be the best you can be, you can do it at Cincinnati Children’s.