Overview
Looking to be part of something more meaningful? At HonorHealth, you'll be part of a team, creating a multi-dimensional care experience for our patients. You'll have opportunities to make a difference. From our Ambassador Movement to our robust training and development programs, you can select where and how you want to make an impact.
HonorHealth offers a diverse benefits portfolio for our full-time and part-time team members designed to help you and your family live your best lives. Visit honorhealth.com/benefits to learn more.
Join us. Let's go beyond expectations and transform healthcare together.
HonorHealth is one of Arizona's largest nonprofit healthcare systems, serving a population of five million people in the greater Phoenix metropolitan area. The comprehensive network encompasses six acute-care hospitals, an extensive medical group with primary, specialty and urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization, community services and more. With nearly 15,000 team members, 3,700 affiliated providers and close to 2,000 volunteers dedicated to providing high quality care, HonorHealth strives to go beyond the expectations of a traditional healthcare system to improve the health and well-being of communities across Arizona. Learn more at HonorHealth.com.
Responsibilities
Job Summary
Ensures all admissions to inpatient or observation from the emergency department, direct admissions, and L&D patients' admissions are authorized, when required, based on payor auth requirements. Notifies patients' insurance plans of admission utilizing payor websites or faxing notification with patient face sheet. Ensures authorization is for appropriate patient class. Verifies patients are covered/eligibility under insurance plan by running real-time eligibility (RTE), when available, using payor websites, or calling payor to obtain the information. Communicates with Admitting Services Intake Counselors when patient's plan is not showing active coverage. Documents EMR/EPIC appropriately according to department standards. Collaborates and communicates frequently with Case Management/UR nurses regarding payor requirements for clinical documentation or updates to patient's medical condition in order to secure appropriate level of authorization for the inpatient or observation admission.
- Works accounts from assigned WQ, confirm correct insurance plan was encoded on account, update if needed. Faxes inpatient or observation notification of admission to payors utilizing appropriate method ensuring payor requirements are met for admission notification and documenting the EMR/EPIC appropriately according to department standards. Communicates with Admitting Services Intake Counselors if patient's coverage is termed or if unable to determine correct coverage with payor information obtained at time of admission.
- Continuously monitors deferred and pending authorization accounts and follows up appropriately and timely with payor for authorization.
- Notifies payor/plan when patient class changes, ensuring auth is reflecting the appropriate patient class. Ensures the Bed Days form is completed accurately, when applicable
- Communicates appropriately with Case Management/UR nurses for clinicals requested by payor or admission authorization denials from payor by following defined workflow and documenting EPIC/EMR appropriately according to department standards.
- Monitors OnBase daily for incoming faxes from payors with authorization information, index documents to appropriate patient account, and document EMR/EPIC Auth/Cert according to defined workflow and department standards.
- Performs other duties as assigned.
Qualifications
Education
High School Diploma or GED Required
Experience
Nine (9) months in healthcare field including medical office insurance/front desk, hospital registration, hospital business office (billing or collections). Required
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HonorHealth
Nov 23, 2024