Medical Policy Specialist jobs in Johnstown, PA

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MINIMUM QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. High school graduate or equivalent.
2. State criminal background check, and federal, if applicable, as required for state department of health (e.g. PA DOH, OH DOH, MD DOH, WV DHHR) regulated areas based on physical work location.

CORE JOB DUTIES AND RESPONSIBILITIES:

The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Obtains demographic/billing/insurance information from patient/family/legal guardian and enters into the registration/billing systems for service and claim processing and scans insurance cards & photo identification. Provides to the patient, information concerning insurance, payment of bills and hospital procedures.
2. May complete managed care responsibilities in regard to obtaining pre-certification and authorizations.
3. Prepares WVU Medicine standard consent form, notice of privacy practice and/or other necessary paperwork related to registration and presents to patient/family/legal guardian for signatures. Obtains electronic signature for consent to treat and patient financial obligations.
4. Collects deposits/co-payments/deductibles/patient liability payments when applicable, provides patient receipt and documents payment in the registration/billing systems.
5. Prepares armband for patient identification.
6. Balances daily receipts and cash drawer for patient payments as needed. Follows up on accounts as indicated by system flags (courtesy dismissal/comments/red stickers).
7. May initiate various screenings and obtains all pertinent information for coverage and completes appropriate paperwork.
8. Performs medical necessity checks and completes Advanced Beneficiary Notice as needed.
9. Schedules, reschedules, or cancels patients in accordance with hospital workflows.
10. Checks for order completeness and validate order against scheduled service.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, and grasping.
2. Visual acuity must be within normal range.
3. Manual dexterity to operate keyboards, fax machines, telephones, and other business equipment.
4. Sitting and/or standing for extended periods of time.
5. Reading and comprehension ability.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. High volume, fast paced environment.
2. Exposure to communicable disease.
3. Frequent interactions with patients, medical staff, and support staff daily on a continual basis.

SKILLS AND ABILITIES:

1. Ability to accurately utilize applicable computer software and equipment for access processing & demonstrates ability to follow down time procedures.
2. Demonstrate knowledge of procedure to report and/or document unsafe/hazardous conditions, incidents and defective equipment in compliance with hospital policy.
3. Requires considerable attention to detail, the ability to be organized and to be able to perform multiple tasks simultaneously.
4. Requires the ability to memorize a considerable amount of information, and to be able to reference information not retained from written sources or from appropriate personnel.
5. Requires the ability to understand medical insurance requirements for payment and basic knowledge of covered services.
6. Excellent written and verbal communication skills and the ability to understand written and verbal communication.
7. Basic knowledge of medical terminology.

Additional Job Description:

Scheduled Weekly Hours:

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Exempt/Non-Exempt:

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