Arkansas children's Insurance Analyst, Dental, Full time in Little Rock, Arkansas
CC015060 Dental Clinic
Serves as a subject matter expert (SME) among the team members, other departments and clinical staff. Promotes a level of professionalism and team leadership, with an ability to multi-task priorities in order to meet departmental goals. Regularly communicates with 3rd party payers (Medicaid, Commercial Insurance etc.) regarding clinical justification and preauthorization for outpatient procedures in Dentistry. Works closely with the clinical team to determine appropriate CDT/CPT/ICD-10- diagnosis codes when needed, and selects the specific clinical reports to be sent to payers for reconsideration. Obtains prior authorizations for high cost outpatient procedures. Analyzes genes listed under certain CPT codes to determine if those genes can be found under another CDT/CPT for justification in accurate payer reimbursement. Works with both internal and external staff and families and coordinates the various progressions for payer’s medical necessity criteria. Coordinates with Patient Finance to guarantee the precise CDT/CPT/ICD-10 codes to be sent to payers for reimbursement. Serves as a Lead in assisting the Manager with quality assurance, performance management, staff development and training in regards to staffing functions.
PRIMARY DUTIES AND RESPONSIBILITIES
- Utilization Review Activities
Collaborates with the appropriate medical staff and members of the health care team for outpatient surgery and outpatient Utilization Review activities.
Communicates clinical information to 3rd party payers (Medicaid, Commercial Insurance, Medicare, Out-of-State Medicaid, Etc.)
Obtains preauthorization approval for outpatient procedures.
Obtains prior authorizations for high cost outpatient procedures.
Works with both internal and external staff and families and coordinates the various progressions for payer’s medical necessity criteria.
Effectively works directly with a variety of departments, physicians, patients, external facilities, payers as well as internal contacts at all levels of the organization; serving as a liaison during the authorization process.
- Coding Activities
Works closely with clinical teams to determine appropriate CDT, ICD-10-CM diagnosis and procedure codes.
Analyzes genes listed under certain CPT codes to determine if those genes can be found under another CPT for justification in accurate payer reimbursement.
Acts as a resource to internal departments for converting from ICD-9 to ICD-10 codes.
Services as a resource to the Utilization Review Coordinators, Admissions and other departments as needed.
- Documentation Activities
Employing current system to conduct insurance verification and obtain preauthorization numbers, which are to be documented thoroughly in order to ensure patient eligibility and benefits, and accurate claims payment.
Manages and distributes daily work assignments to the team, and tracks individual job performance by completion results.
Maintains and manages a current reminder list of all follow-up work, and can execute the necessary reports for the team out of the electronic system.
- Leadership and Effectiveness
Must be able to manage multiple responsibilities in an effective manner, problem solve, work independently, as well as a team member in various settings, and possess excellent organizational skills.
Effectively communicate both verbally and written, and be able to interact with all levels of healthcare professionals, patients and peers in a positive and professional manner.
Assists manager in providing training and guidance to fellow staff members as needed.
Provides information to Manager in identifying possible areas of concern that could impact the accuracy and effectiveness of the departments work efforts or organizational goals.
Overall work is completed within 3 business days, and follow-up requests are handled within 24 hours.
Ability to understand the mission of Arkansas Children’s and to implement it into daily activities.
Required - Associate's degree or equivalent from two-year college program or technical school or nursing diploma - Field of Study: Healthcare or Business Administration (Medical Coding Experience), or Or two years related experience and/or training; or equivalent combination of education and experience.
Preferred - Bachelor's degree from four-year college or university - Field of Study: Healthcare or Business Administration (Certified Coding Certification)
Required - 4 years total experience required, which includes 4 years of obtaining prior authorizations in a medical setting, with a basic understanding of medical terminology. experience
Preferred - 1 years Medical Coding experience experience preferred
CERTIFICATION / LICENSE / REGISTRY REQUIREMENTS
Preferred - National Coding Certification
Required - Demonstrated ability to manage time both effectively and efficiently through prioritizing multiple tasks and establishing priorities in order to maintain a high level of quality standards.
Required - Excellent interpersonal skills in being approachable and team oriented, building strong working relationships and a positive work environment.
Required - Accomplishing tasks by considering all areas involved, no matter how detailed; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
Required - Under minimal direction and supervision, performs independent work as assigned.
Required - Computer literate which includes an understanding and effective utilization of the internet and other software products.
Lifting/Pushing/Pulling Weight-Up to 10 pounds-Regularly
Lifting/Pushing/Pulling Weight-Up to 25 pounds-Frequently
Lifting/Pushing/Pulling Weight-Up to 35 pounds-Occasionally
Physical Activity-Climb or balance-Occasionally
Physical Activity-Reach with hands and arms-Frequently
Physical Activity-Stoop, kneel, crouch, crawl, twist, or bend-Occasionally
Physical Activity-Talk or hear-Regularly
Physical Activity-Taste or smell-Occasionally
Physical Activity-Use hands to touch, handle, or feel-Regularly
Physical Environment-Inside Office Environment / conditions-Regularly
Safety Sensitivity-This position has been designated as safety sensitive.-Required
Children are at the center of everything we do. Arkansas Children’s (https://www.archildrens.org/contentpage.aspx?nd=919) is the only hospital system in the state solely dedicated to caring for children, which allows our organization to uniquely shape the landscape of pediatric care in Arkansas.
As Champions for Children, Arkansas Children’s Hospital has joined the elite 6 percent of hospitals in the world that have Magnet Status (http://www.archildrens.org/contentpage.aspx?nd=2489) . Magnet recognition from the American Nurses Credentialing Center (ANCC) is the most prestigious distinction a healthcare organization can receive for nursing excellence and quality patient outcomes.
Arkansas Children’s is driven by four core values: safety, teamwork, compassion and excellence. These values inform every decision and every action, from the aggressive pursuit of zero hospital infections to treating each family with dignity, kindness and concern. These core values fundamentally guide our work at Arkansas Children’s.
For more than a century, Arkansas Children’s has continuously evolved to meet the unique needs of the children of Arkansas and beyond. Today, Arkansas Children’s is more than just a hospital treating sick kids – our services include two hospitals, a pediatric research institute, a foundation, clinics, education and outreach, all with an unyielding commitment to making children better today and healthier tomorrow.
Arkansas Children’s reaches more children in more ways where they live, learn and play. Our system includes a 336-bed hospital in Little Rock with the state’s only pediatric Level 1 Trauma Center, burn center, Level 4 neonatal intensive care and pediatric intensive care, and research institute as well as a nationally-recognized transport service. We are nationally ranked by U.S. News World Report (https://www.archildrens.org/health-and-wellness/news/news-story?news=123) in four specialties (2017-18): Pediatric Cardiology & Heart Surgery, ranked No. 37; Neonatology, No. 38; Pediatric Pulmonology, ranked No. 47; and Pediatric Urology, ranked No. 48. A sister campus, Arkansas Children’s Northwest (http://www.archildrens.org/contentpage.aspx?nd=3691) , opened in February 2018, bringing 233,613 square feet of inpatient beds, emergency care, clinic rooms and diagnostic services to children in that corner of the state.
Arkansas Children's provides equal employment opportunity to all persons without regard to age, race, color, religion, national origin or citizenship status, disability, military status, sexual orientation, gender identity or expression, pregnancy or any other category protected by federal, state and local laws. Further, Arkansas Children's will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant.