<p>Job Details</p> <p>Do you want to work at one of the Top 100 Hospitals in the nation? We are guided by our values of Love and Excellence and are passionate about delivering health, not just health care. Come join us at ChristianaCare!</p> <p>ChristianaCare, with Hospitals in Wilmington and Newark, DE, as well as Elkton, MD, is one of the largest health care providers in the Mid-Atlantic Region. Named one of "America's Best Hospitals" by U.S. News & World Report, we have an excess of 1,100 beds between our hospitals and are committed to providing the best patient care in the region. We are proud to that Christiana Hospital, Wilmington Hospital, our Ambulatory Services, and HomeHealth have all received ANCC Magnet Recognition.</p> <p>PRIMARY FUNCTION:</p> <p>Collaborates with ordering providers and practices to ensure a seamless delivery of services facilitated by pre-authorization process. Promotes provider and patient satisfaction by minimizing their involvement with 3rd party insurance providers for preauthorization. Provides efficient and timely information to optimize care delivery and avoid billing denials. Enters authorization information into appropriate systems to ensure scheduling and billing requirements are met.</p> <p>PRINCIPAL DUTIES AND RESPONSIBILITIES:</p> <ul> <li> <p>Obtains preauthorization, in collaboration with the ordering provider for any medical service or procedure that the payor deems necessary.</p> </li><li> <p>Communicates patient demographic and clinical information to 3rd party insurance providers, for referral and precertification requirements.</p> </li><li> <p>Performs daily operational duties utilizing appropriate systems, patient EMR record as well as billing system, and multiple insurance databases.</p> </li><li> <p>Maintains a solid working knowledge of insurance and billing requirements related to medical services and procedures for maximum reimbursement of claims and to minimize financial risks.</p> </li><li> <p>Coordinates with patient financial services to investigate and resolve billing discrepancies/denials.</p> </li><li> <p>Coordinate forms and communication with internal, customer service team for patient assistance programs.</p> </li><li> <p>Coordinates with ordering providers to facilitate peer to peer reviews for denials, while identifying trends to reduce the necessity of peer review.</p> </li><li> <p>Participates in quality assurance as directed to assure ongoing improvement in departmental and individual performance</p> </li><li> <p>Demonstrates compliance with Christiana Care and departmental policies and procedures and mandatory education requirements including but not limited to safety, infection control, attendance, and dress code.</p> </li></ul> <p>SCOPE, PURPOSE, AND FREQUENCY OF CONTACTS:</p> <p>Primary contact and interactions to include: Departmental and hospital staff, physicians/office staff, patients/family, insurance companies, Patient Financial Services and Information Services.</p> <p>EDUCATION AND EXPERIENCE REQUIREMENTS:</p> <ul> <li> <p>Associate degree in Business/Medical related field preferred.</p> </li><li> <p>Two years experience in a medical, financial or marketing institution preferred.</p> </li><li> <p>Previous insurance or third-party experience is preferred</p> </li><li> <p>Ability to manage multiple software/websites simultaneously</p> </li><li> <p>An equivalent combination of education and experience may be substituted.</p> </li></ul> <p>KNOWLEDGE, SKILL, AND ABILITY REQUIREMENTS:</p> <ul> <li> <p>Exemplify prioritization and organization skills.</p> </li><li> <p>Demonstrate critically thinking and problem-solving skills</p> </li><li> <p>Produce quality work with minimal errors</p> </li><li> <p>Ability to follow written and verbal direction</p> </li><li> <p>Adjusts to change, pressure and manage multiple concurrent responsibilities.</p> </li><li> <p>Ability to effectively communicate orally, written and electronically.</p> </li><li> <p>Exhibit ChristianaCare core values</p> </li><li> <p>Embodies quality patient-focused customer service</p> </li><li> <p>Ability to work as a team member and/or independently within guidelines.</p> </li><li> <p>Ability to train/orient in an efficient and effective manner.</p> </li></ul> <p>Post End Date</p> <p>May 30, 2025</p> <p>EEO Posting Statement</p> <p>Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.</p>