Community Health Systems Insurance Verify Rep in Sarasota, Florida

Description:

  • Provideprofessional, accurate, timely insurance verification and notification foroutpatient diagnostic services, observation and inpatient services.

  • Responsiblefor the timely verification of medical insurance benefits for the servicescheduled or service being provided via website and/or calling the payor (ManagedCare payors, Governmental payors and Commercial payors)

  • Verifiesinsurance eligibility, benefits and preauthorization/precertification/referralguidelines following the 16 components of verification

  • Meetsall required standards for assuring thorough documentation of the 16 componentsof insurance verification where applicable based on payor

  • Ensureall account activity is documented in the computer system timely and thoroughly

  • Usingpayor websites and documentation provided by the physician s office determineif the scheduled service is medically necessary based on payor guidelines byCMS and commercial payors

  • Workingknowledge of Medical Necessity protocols for scheduled tests and procedures andnotifies physician office of any tests that do not meet necessity guidelines

  • Communicatesand educates patients and physician practices to ensure compliance withidentified payor requirements as needed

  • Validatesthat all necessary referrals, pre-certification and/or authorizations forscheduled service are on file and that they are valid for the scheduled testbeing performed

  • Reviewsand resolves preauthorization/precertification/referral issues that are notvalid and contacts insurance carriers to verify/validate requirements to ensureaccuracy and avoid potential denial and contact ordering physician office ifnecessary to have authorization submitted

  • Calculatespatient estimated portions via estimation tool and contacts patient prior tothe scheduled appointment to notify patient of their patient responsibility

  • NotifyBenefit Verification Manager immediately when uninsured or underinsuredpatients are identified

  • Responsiblefor maintaining performance standards that ensure the department is operatingat peak proficiency and that established goals are consistently being met.

  • Workis performed under tight deadlines.

  • Maintaineffective communication with patients, physicians, medical office staff and theHealth Management facilities and departments.

  • Maintainingcurrent knowledge and understanding of government rules, regulations.

  • Abilityto work with technology necessary to complete job effectively. This includes,but is not limited to, SCI, phone technology, PULSE/DAR products, insuranceverification / eligibility tools, patient liability estimation tools, and scanningtechnology.

  • Abilityto perform all other duties as assigned or requested.

Qualifications

  • High School graduate or equivalent

  • Minimum one (1) year experience in a medical facility, ambulatory surgery facility, or acute-care hospital working with insurance verification

  • Knowledge of CPT, HCPCS, ICD-9 and medical terminology

  • Excellent interpersonal skills required to communicate with direct staff and internal/external customers

  • Must possess excellent time management and organizational skills

Job: Business Office Support

Organization: Shared Services Center - Sarasota

Location: FL-Sarasota

Requisition ID: 1755798