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Penn Medicine, University of Pennsylvania Health System · 6 days ago

Intake Referral Representative - Full Time

King of Prussia, PA

Full-time

Onsite

Entry Level

2+ years exp

Penn Medicine is dedicated to providing high-quality patient care, conducting innovative research, and educating future medical leaders. The Intake Referral Representative will coordinate intake and admission activities for patient referrals, ensuring effective communication for admissions processing and managing prior authorizations for services.

BiotechnologyEducationHealth CareMedicalTraining

Responsibilities

Maintains updated knowledge of third-party requirements and guidelines Financially qualifies each referral or restart for servicing through advanced knowledge of reimbursement methodology and procedures, and Medicare requirements prior to acceptance on service

Negotiates pricing, as required, with payers, case managers and agents according to established guidelines

Advises supervisors and obtains approval prior to acceptance, for pricing requests below established guidelines and/or charity care

Develops, collects and distributes required admission forms for signature by the patient within established time frame

Maintains updated knowledge of the CPR+ System Exhibits proficiency in all areas of the CPR+ Admission System, including but not limited to: entry of patient personal data, selection and entry of appropriate insurance companies, management of payer master file, support of patient medical history file, and price matrix development and editing

Troubleshoots and corrects problems associated with price matrix file maintenance

Actively participates in group training sessions and requests personal assistance in areas of weakness

Assists patients with questions regarding insurance matters Displays proficiency in explaining co-pay, deductible and financial obligation to patients

Utilizes appropriate judgment in resolving issues surrounding limited financial resources, non-covered therapies and charity requests

Supports Ongoing Patient Qualification Process Reviews and interprets Medicare, Medicaid and third-party payer guidelines to determine appropriateness of diagnosis and related therapy(ies) for reimbursement purposes, prior to acceptance on service as needed

Investigates alternative payment sources for reimbursement of anticipated costs to be incurred by patients determined to have no coverage

Researches and investigates all potential avenues of reimbursement for all patients, prior presenting to supervisors for rejection of service

Re-verifies patient insurance status and financial obligation on a quarterly basis, and as requested by Supervisor and/or billing department

Clearly documents detailed information regarding therapy, diagnosis and method of administration to support accurate and timely reimbursement of charges for each patient serviced

Qualification

Insurance VerificationPrior AuthorizationPatient RegistrationReimbursement MethodologyCommunication Skills

Required

H.S. Diploma/GED (Required)

2 years of experience in a related field such as Billing, AR, Insurance Verification, Pharmacy Technician, or Home Infusion

Preferred

Associate of Arts or Science

Education Specialization: Business Administration

Benefits

Prepaid tuition assistance programs

Company

Penn Medicine, University of Pennsylvania Health System

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Penn Medicine is a world leader in academic medicine, setting the standard for cutting-edge research, compassionate patient care, and the education of future health care professionals.

Founded in 1765

Philadelphia, Pennsylvania, USA

10001+ employees