Required: Working knowledge of third party payer verification terminology Working knowledge in the functional operations of third party payors and utilization review agencies to expeditiously coordinate follow-up Working knowledge of State and Federal programs to ensure reimbursement from Medicare, Medi-Cal, CCS programs, out-of-state Medicaid, or other sponsoring agencies Working knowledge of health plans with special processing requirements for emergency patients and ability to effectively communicate these requirements to physicians and administrative personnel under time urgent conditions. Ability to scrutinize credit reports and evaluate personal financial information to detect any problems, discrepancies or questionable areas and set up an appropriate financial arrangement when necessary (May be trained) Ability to attend to many details within a short span of time Knowledge of the availability of specific accommodations for patients on various nursing units to initiate proper room and care charges (May be trained) Skill in detecting erroneous data input that would otherwise disable census system output mechanism Working knowledge of HMO’s and PPO’s, in order to understand, explain and calculate Per Diem rates, contractual allowances and percentage discounts. Skill in computing rations, rates and percentages in order to calculate estimated pro-rated balances and patient liability. Skill in analyzing information, problems, situations, practices or procedures in order to define the problem/objective; identify relevant concerns/factors; identify patterns, tendencies or relationships,; formulate logical and objective conclusions; recognize alternatives and their implications Preferred: Working knowledge of the department functions of an acute care hospital and their organizational interrelationships Knowledge of physician team and specialty to accurately validate medical services rendered to patients Ability to monitor bed availability, predict, and communicate possible problems to appropriate departments
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