Appleton, Wisconsin
Pre-Authorization Supervisor Job Opening in Appleton, Wisconsin - Applies a thorough knowledge of complex payer rules, regulations, policies, and procedures as they impact the pre-authorization and billing processes to optimize payments to Catalpa Health.
Understands all insurance and Medicaid payor contracts.
Develops and maintains strong relationships with key contacts at insurance companies and Medicaid to further contracting relationships with Catalpa Health.
Researches and manages highly sensitive and complex patient inquiries and billing issues.
Maintains detailed knowledge of the authorization system and develops a strong hands-on working relationship with Catalpa?s billing vendor.
Interacts with Medicaid and insurance company representatives to ensure up-to-date interpretation of coverage, resolution of related problems and proper follow-up.
Develops and maintains effective professional relationships with representatives of payer organizations in order to facilitate payment and appeals of payer decisions.
Interprets complex regulations, policies and contracts.
Oversees the Medicaid reimbursement process, including primary insurance exhaust and secondary Medicaid payments occur timely.
Works closely with billing vendor on denials.
Coordinates Catalpa Cares charity care program.
Serves as Privacy Officer to create policies and procedures, establish employee training for compliance with HIPAA and handles all issues related to HIPAA.
Job Type: Full-time
Required education:
Bachelor's
Required experience:
healthcare/hospital & billing supervisory: 5 years
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