Financial Investigator

Job Title

Secure pre-authorizations for medical and ancillary services. Communicate on a daily basis with practice managers, clinicians and staff to ensure that visits are appropriately registered, and meet all insurance pre-authorization requirements.

Responsibilities

• Establish and maintain positive relationships with patients, visitors, and other employees. Interacts professionally, courteously, and appropriately with patients, visitors and other employees. Behaves in a manner consistent with maintaining and furthering a positive public perception of BronxCare Health System and its employees.
• Contributes to and participates in the Performance / Quality Improvement activities of the assigned department. Contribution and participation includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality Improvement (CQI) teams, consistent adherence to the specific rules and regulations of the BronxCare Health System (a) Safety and Security Policies, (b) Risk Management : Incident and Occurrence Reporting, (c) Infection Control Policies and Procedures and (d) Patient and Customer Service.
• Insures authorization requests are obtained and processed for medical and ancillary services on a timely basis and manage the accurate submission of authorization requests and the entry of authorization to Allscripts Clinical Registration System
• Responds in a timely manner to the pre-authorization, authorization and pre-certification requests of various points of service areas located within BronxCare Health System's ambulatory practices.
• Retrieves and reviews patient utilization data to secure authorization for scheduled services. Updates BxCare practice administrative personnel and Care Providers regarding authorization decisions rendered by insurance carriers
• Navigates Allscripts EMR (Acute Care) and communicates with Practice Administrative staff or Care providers to retrieve required clinical utilization data to facilitate insurance carrier review and expeditious authorization approval
• Communicate on a daily basis with practice managers, clinicians and PFS staff to ensure that visits are appropriately registered, meet all insurance pre-authorization requirements and increase revenue by reducing payment denials for unauthorized services.
• Maintains accurate and complete reporting deliverables showing productivity and outstanding items to be addressed, conducts follow up on outstanding cases as needed.
• Act as a liaison with clinics, physicians, patients, staff, insurers and ancillary departments and maintain a positive relationship with all.
• Maintain the highest level of professionalism and confidentiality at all times to ensure compliance with Federal / State regulations such as HIPAA and EMTALA..

Qualifications