Employment Type:

Full time

Shift:

Day Shift

Description:

Waterloo Medical Center
Full-Time (1.0 FTE) 80 Hours Biweekly
8 Hour Day Shift

Under the general guidance of the Director of Rehabilitation Services, responsible for leading outpatient therapy patient insurance eligibility and authorizations ensuring accuracy and compliance for each individual. Responsible for implementing and teaching information related to admitting, billing and insurance functions to other stakeholders, and delegating tasks when appropriate. Ensures accuracy with all aspects of outpatient therapy related to admitting, billing and insurance.

ESSENTIAL FUNCTIONS

• Responsible for performing department daily scheduling, registration, and all insurance activities for outpatient rehabilitation services.
• Understands physical, occupational and speech therapy services and can utilize systems to ensure appropriate therapy CPT and ICD-10 codes were utilized.
• Reviews rehab denials and write-off reports and is directly involved in the appeal processes.
• Monitors payer websites to maximize reimbursement based on services delivered. Performs pre-service check processes, including pre-authorization and medical necessity review as indicated by patient insurance carrier.
• Applies knowledge of specific payer payment rules to ensure timely claim resolutions.
• Reviews, provides, and submits additional information, including medical necessity and documentation for appeals, as necessary.

MINIMUM QUALIFICATIONS

• Registered Nurse Preferred
• Education: High school diploma or equivalent; knowledge of medical terminology is preferred. Associate degree in finance, accounting, business administration, or related field, preferred or relatable experience.
• Experience within a hospital or clinic environment performing prior-authorizations and denial management, preferred.
• Knowledge of insurance and governmental programs, regulations, and billing processes, preferred.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.