Job Summary:
Analyze OP admits for appropriate billing requirements involving Advanced Beneficiary Requirement (ABN) waivers, pre-authorizations, referrals, correct insurance demographic information and medical necessity pertaining to documentation and coding. Will interact with referring physicians, patients, hospital and MSG staff ensuring quality demographic and clinical information is obtained at the time of scheduling or prior to when the exam is ordered. Assist with pre-authorization as needed and coordinate any pre-registration requirements with Patient Access Services. Conduct ongoing internal audits and maintain all documentation. Review and analyze insurance denials, identifying problem areas and recommending and coordinating corrective actions. Review orders for appropriate clinical indications and provide ICD-10 coding. Monitor new billing/compliance regulations for both the Hospital and MSG to determine the impact on operations and charging issues.
Minimum Qualific...