Specialist

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine.

Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance.

Our employees shape our future each day. Are you living your life's work?

Summary :

This position is responsible for ensuring financial security of Radiology exams and procedures, include verification of benefits, ensuring medical necessity coverage, order compliance, and obtaining needed precertification and correcting registration data as needed.

The role also includes working with other areas of the institution and department to ensure patients are provided excellent service.

Responsibilities :

Demonstrates professionalism and sensitivity in all patient / caregiver interactions. Observes and proactively acts to give directions, to answer questions or to provide information or reassurance regarding billing and financial matters as necessary.

Counsels patients and family members on possible coverage issues or problems and provides alternatives.

• Reviews and updates patient demographic and insurance data to ensure that the information is correct and complete.
• Verifies insurance eligibility and insurance data to determine coverage and benefits for services being performed. Obtains and verifies prior authorization and referrals for services being performed, documenting the prior authorization / referral information in EPIC.

Reviews all high-tech radiology studies for medical necessity, precertification completion, protocol applicability, compliant orders.

Obtains authorizations from carriers for specified services for all same day service requests or add-on services. Follows up with patients and / or referring sources for all "pended" or "denied" authorization requests.

Confirms that the required precert / authorization information is correctly listed in EPIC. Reschedules patients as needed.

Conducts screening of the diagnosis and test requested to determine if the diagnosis supports the medical necessity of the testing being requested.

When necessary, secures a physician's order / script or updates to physician's order script, with ICD10 Codes and / or a narrative diagnosis, procedure, and physician's signature to support the medical necessity of testing being performed.

• Documents the out of pocket responsibility from the patient for services being performed.

Education or Equivalent Experience :

• Associate of Arts or Science
• Some college related to healthcare, business or human services. Experience related to Healthcare, business or human services.
• H.S. Diploma / GED (Required)
• 4 years responsible positions in physician billing operations and accounts receivable management. Specific knowledge of precertification requirements, CMS medical necessity requirements, third party billing processing procedures is ideal.

Experience in the insurance industry or in an academic medical center highly preferred, as well as general knowledge of insurance company procedures and the dynamics of health care systems.

Related to healthcare, business, or human services

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy.

We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region.

Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

Last updated : 2024-03-03