Medical Policy Specialist jobs in Philadelphia, PA

Essential Duties and Responsibilities:

Responsible for completing the check-in/ registration process according to guidelines by; accurately entering all pertinent patient information, confirming insurance benefit eligibility completion at the time of service, collecting and posting copayments, preparing electronic encounters in EPM and EHR for billing and clinical use, confirming referring physicians, obtaining and entering all meaningful use criteria, enrolling patients in Patient Portal, including necessary paperwork brought in by patient or sent in by referring OD for the doctors to review, and reconciling all copayments collected.

Responsible for completing the check-out/ discharge process according to guidelines by; providing patients with their next appointment as indicated on fee ticket, forwards MRI and Medicaid precertification requests to appropriate personnel, and reconciles daily collections then forwards all fee tickets to the billing staff daily.

Responsible for auto enrolling our patients onto the practices Patient Portal. Educating the patients of the benefits of enrolling on our Patient Portal and giving them the information needed to gain access. In addition, encouraging patients to utilize the portal for communicating with our practice and the benefits the portal can provide by keeping them engaged in the care they receive. Each Patient Advocate is required to assist at least one patient per day by helping the patients log on the portal and submitting a secure message to our practice.

Scans and files all patient documents accumulated daily in DM by the end of each business day.

Retrieves messages from Call Center Triage and forwards to appropriate personal in a timely manner. Updates Telephone Call Templates with physician responses and generates document when completed.

Documents and records all phone calls, fax submissions, incoming mail, and patient interactions that require the assistance of personnel or other department for communication purposes.

Assists medical personnel with returning messages such as patient inquiries.

Ensures patient referral source is kept abreast of patient care by entering or submitting all new referring physicians to the Referral Management Department for entry in the provider database or attaching updated physician’s contact information to the patients’ electronic chart in all designated areas.

Submits patients referred VIA fax/ Referring OD to the Referral Management Department. All scheduled patients must have their referral letters scanned into DM and noted in the system.

Contacts and reschedules no show appointments and assists with internal scheduling conflicts.

Forwards on demand precertification and insurance verification requests to appropriate personnel.

Maintains and controls the release of information to authorized persons only.