Community Health Systems Benefit Verification Specialist in Fort Smith, Arkansas
· Provide professional, accurate, timely insurance verification and notification for outpatient diagnostic services, observation and inpatient services.
· Responsible for the timely verification of medical insurance benefits for the service scheduled or service being provided via website and/or calling the payor (Managed Care payors, Governmental payors and Commercial payors)
· Verifies insurance eligibility, benefits and preauthorization/precertification/referral guidelines following the 16 components of verification
· Meets all required standards for assuring thorough documentation of the 16 components of insurance verification where applicable based on payor
· Ensure all account activity is documented in the computer system timely and thoroughly
· Using payor websites and documentation provided by the physician s office determine if the scheduled service is medically necessary based on payor guidelines by CMS and commercial payors
· Working knowledge of Medical Necessity protocols for scheduled tests and procedures and notifies physician office of any tests that do not meet necessity guidelines
· Communicates and educates patients and physician practices to ensure compliance with identified payor requirements as needed
· Validates that all necessary referrals, pre-certification and/or authorizations for scheduled service are on file and that they are valid for the scheduled test being performed
· Reviews and resolves preauthorization/precertification/referral issues that are not valid and contacts insurance carriers to verify/validate requirements to ensure accuracy and avoid potential denial and contact ordering physician office if necessary to have authorization submitted
· Calculates patient estimated portions via estimation tool and contacts patient prior to the scheduled appointment to notify patient of their patient responsibility
· Notify Benefit Verification Manager immediately when uninsured or underinsured patients are identified
· Responsible for maintaining performance standards that ensure the department is operating at peak proficiency and that established goals are consistently being met.
· Work is performed under tight deadlines.
· Maintain effective communication with patients, physicians, medical office staff and the Health Management facilities and departments.
· Maintaining current knowledge and understanding of government rules, regulations.
· Ability to work with technology necessary to complete job effectively. This includes, but is not limited to, SCI, phone technology, PULSE/DAR products, insurance verification / eligibility tools, patient liability estimation tools, and scanning technology.
· Ability to perform all other duties as assigned or requested.
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: Credit & Collection
Organization: Shared Services Center - Fort Smith
Location: AR-Fort Smith
Requisition ID: 1837316
This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment.