Pediatric Services Support Representative

Emeryville, CA 94608

Job ID: 104262 Job Category: Healthcare-Medical Pay Rate: DOE

Job Title       :       Pediatric Services Support Representative

Location       :       Emeryville, CA 94608

Duration       :      1+ Months contract (Higher possibility to extend)

About Client: Our Client serves the local, regional and global communities by forming strategic alliances and developing strong partnerships to improve health, enhance opportunities for education and foster research collaborations around the world.

Summary: 

  • Responsible for obtaining authorizations for all CCS population for inpatient admissions, outpatient surgeries/procedures and outpatient visits or services.
  • Should verify demographic and clinical information relevant to the patients visit.
  • Should confirm Medi-Cal eligibility and provides notification for established patients or initiates new patient referrals to CCS for inpatient admissions, outpatient surgery and procedures analyzing and identifying appropriate CPT (Current Procedure Terminology) procedural codes and ensuring that CCS insurance coverage is properly attached and documented in the electronic  health record (APeX system). 
  • In the event of rescheduling admission due to any issues, the representative will ensure that all parties are informed to ensure that proper follow up is maintained.
  • Retrieves clinical information, completes appropriate forms and submits authorization requests for CCS population.
  • Responsible for resolving individual account authorization or coverage issues. 
  • Verify insurance eligibility and benefits by utilizing Real-Time Eligibility (RTE), government-sponsored program web sites, and Hospital Account Record (HAR) notes identifies whether patient’s primary insurance coverage is either an HMO or PPO in order to determine whether patient is eligible to be referred to CCS for possible eligibility.
  • Responsible for all aspects of financially securing CCS insurance and authorization data for patient services.
  • Update any deficiencies in patient registration information and document all identified pertinent information received.
  • Should secure authorizations and properly notate all activity in client’s electronic health record system. 
  • Conducts reviews and facilitates claim edit audits for requests for information (RFI's) within APeX system from billing groups to facilitate claims and proper billing.  Resolving claim edits is necessary for account payment and resolution
  • Should update and maintain own file of procedures, notices of changes, etc., so that related knowledge and skills are always current.
  • Should be willing to work flexible hours that includes weekends, overtime and other shifts as assigned.
  • Requires flexibility to orient and work at all client’s locations.

Required Experience And Certification:

  • Should have a high school diploma or GED.
  • Should have minimum three years of clerical experience, including two  years at the Admitting Worker or comparable level.
  • Be proficient in health insurance eligibility and authorization requirements.
  • Should have knowledge of government program regulations, Medi-Cal, CCS, and third party payors’ patient liability determination.
  • Should have excellent customer service skills to interact with medical providers, clinic and department staff and CCS county offices.  
  • Should have knowledge of office machines, experience with  ADT and basic computer skills.
  • Should have basic knowledge of medical terminology.

About ASK:  ASK Staffing is an award-winning technology and professional services recruiting firm servicing Fortune 500 organizations nationally. With 5 nationwide offices, two global delivery centers, and employees in 42 states-ASK Staffing connects people with amazing opportunities.

Contact:

Regina:               reginat@askstaffing.com               - 678-310-2892

Sabrina:              sabrinat@askstaffing.com             - 678-487-8581 

Sabrina Tella
Trainee Resource Specialist


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