This position is primarily responsible for processing and obtaining prior authorizations for all Medicare, Medicaid and Third Party payor equipment delivered by WSS and order confirmations. This includes but is not limited to preparing, sending and receiving authorizations, and all paperwork required to process the order.
- Patient and Family Centered Care
- Actively engages the patient and family, as applicable, by exhibiting respect and dignity, sharing information in a timely and unbiased manner, and welcoming and encouraging participation to achieve shared decision making.
- Collaborates with other members of the team, including the patient and family, to achieve the ideal patient care experience.
- Determine patient’s eligibility, coverage and insurance limitations.
- Prepare and send prior authorizations as required by the patient’s insurance(s).
- Ensure all documentation is received, complete and correct and within the set timelines
- Follow up on outstanding Prescriptions, Letters of Medical Necessity, Face to Face, Physician Notes and all paperwork needed to process the order, as determined by the patients’ insurance(s).
- Create ADMC and ABN’s. Process quotes and payments for Private Pay orders. Prepare and Provide patients with an Estimate of Cost and collect out of pocket payments upfront per department guidelines
- Ensure all insurance guidelines have been met.
- Verify all HCPC codes and related modifiers for billing purposes.
- Perform all Confirmation duties; confirm delivery and pick-up tickets, and Physician Orders.
- Provide training for new and existing employees with the CRT authorization procedures.
- Run the confirmed orders billing log report daily.
- Run and work the Billing Hold Report weekly.
- Work 1-31 filing system.
Other Related Duties:
- Establish and maintain electronic and hard copy records per department guidelines.
- Maintain Authorization and Confirmation training manuals as needed.
- Process credit cards, cash sales, and checks.
- Follow department guidelines for phone calls, fax and emails.
- Comply with all University of Michigan and departmental standards and expectations.
- Supports the department’s commitment to continuous improvement activities and principles through positive and respectful contribution in all problem-solving and change processes at Home Care Services.
• A high school diploma.
• 5-8 years of professional and/or educational experience.
• 5 year of experience with insurance eligibility, benefit and coverage determination
• Good working knowledge of medical terminology.
• Ability to manage multiple functions simultaneously.
• Excellent interpersonal skills.
• Demonstrated proficiency with computer skills including keyboarding and Microsoft programs
• Experience working with health care professionals is preferred.
• Experience obtaining insurance authorizations and appealing denials.
• 5 years of experience in Complex Rehabilitation reimbursement/insurance coverage is desired.
2850 S.Industrial Hwy., Suite 200, Ann Arbor MI 48104
Indicate in the posting that there are two positions available.
Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act.
Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
Job openings are posted for a minimum of seven calendar days. This job may be removed from posting boards and filled anytime after the minimum posting period has ended.
U-M EEO/AA Statement
The University of Michigan is an equal opportunity/affirmative action employer.