Children's Specialized Hospital is the nation's leading provider of inpatient and outpatient care for children from birth to 21 years of age facing special health challenges - from chronic illnesses and complex physical disabilities like brain and spinal cord injuries, to developmental and behavioral issues like autism and mental health. At 13 different New Jersey locations, our pediatric specialists partner with families to make our many innovative therapies and medical treatments more personalized and effective...so children can achieve more of their goals.
Responsible for providing exemplary customer service while interacting with all customers internal and external. Performs patient interviews. Participates in the Admission Intake. Completes pre-determination -financial clearance for all new and recurring patients. Contacts insurance companies to determine patient's benefits and will suggest other sources of funding to maintain the patient continuum of care. Communicates with Clinicians, Team Leads, and Manager of Payer Services IV&A. Verifies registration information for patients ensuring that all information is in the hospital information system is accurate and complete.
Essential Job Functions
* Assures and completes a pre-determination for insurance coverage for all new and recurring outpatients seeking services at CSH. These service lines include Occupational, Physical, Speech Therapy, Psychology, Chronic Pain Evaluations, Botox and Alcohol Blocks. Will inform families of their financial responsibility (if any) and insurance benefits. * Works with Payer Services department for per diem negotiation for individual patients with their respective insurance company-managed care organization. * Notifies parents of availability of financial assistance programs. Specifically: NJ FamilyCare, CSH Benefit Fund. Distributes application and follows up as necessary. * Serves as liaison between Payer, Patient Accounts, Therapist, Clinician, and the Patient's parent-guardian with respect to financial issues. * Maintains Authorizations and re-authorizations, notifies clinical departments of authorization status and the need for re-authorization when necessary. Notifies parents of authorization status as necessary. * Maintain an organized financial record for all patients interviewed. Provides detailed notes in the hospital information system as documentation of all contact with payers, and-or parents. * Informs the clinical area-patient care coordinators and parents of any denials. * Other tasks assigned by management.
Requirements Formal Education and Job-Related Experience
* Some college or equivalent preferred. Minimum of one to five years of hospital financial experience either in Patient Access Services or Patient Financial Services.
Education and Experience - Additional Comments
* Flexible, hardworking individual with the ability to manage multiple tasks. Must be self-motivated and work well in a team environment. Excellent customer services skills. Healthcare-insurance background preferred. Sound problem solving and communication skills. Ability to professionally inter-relate with people (i.e., parents, staff, patients, Managed Care Organizations, outside agencies, etc.) familiarity with computer software packages (Microsoft Office). Ability to organize and follow specific instructions. Maintain patient confidentiality. Knowledge of NJ financial programs (Medicaid, Charity Care). The competence to communicate a financial plan for the patient.
Job Specific Contacts
* Constant contact with Hospital staff, parents, patients, managed care organizations and outside agencies.
* Typical office environment.
Working Environment - Additional Comments
* Concentration. manual dexterity, lift-pull boxes, push-pull wheel chair, sensitivity to coworkers and clients.
Job Provides Direction To
* None * Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities. * Please view Equal Employment Opportunity Posters provided by OFCCP here. * The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)