Community Health Systems Business Office Lead - PAU in Sarasota, Florida


  • Serve as an example toother Benefit Verification Associates

  • Assist BenefitVerification Manager with verification coverage based on verification volumeneeds

  • Assist with QA andeducation to enhance Benefit Verification skills and processes

  • Provide professional,accurate, timely insurance verification and notification for outpatientdiagnostic services, observation and inpatient services.

  • Responsible for the timelyverification of medical insurance benefits for the service scheduled or servicebeing provided via website and/or calling the payor (Managed Care payors,Governmental payors and Commercial payors)

  • Verifies insuranceeligibility, benefits and preauthorization/precertification/referral guidelinesfollowing the 16 components of verification

  • Meets all requiredstandards for assuring thorough documentation of the 16 components of insuranceverification where applicable based on payor

  • Ensure all accountactivity is documented in the computer system timely and thoroughly

  • Using payor websites anddocumentation provided by the physician s office determine if the scheduledservice is medically necessary based on payor guidelines by CMS and commercialpayors

  • Working knowledge ofMedical Necessity protocols for scheduled tests and procedures and notifiesphysician office of any tests that do not meet necessity guidelines

  • Communicates and educatespatients and physician practices to ensure compliance with identified payorrequirements as needed

  • Validates that allnecessary referrals, pre-certification and/or authorizations for scheduledservice are on file and that they are valid for the scheduled test beingperformed

  • Reviews and resolvespreauthorization/precertification/referral issues that are not valid andcontacts insurance carriers to verify/validate requirements to ensure accuracyand avoid potential denial and contact ordering physician office if necessaryto have authorization submitted

  • Calculates patientestimated portions via estimation tool and contacts patient prior to thescheduled appointment to notify patient of their patient responsibility

  • Notify Benefit VerificationManager immediately when uninsured or underinsured patients are identified

  • Responsible formaintaining performance standards that ensure the department is operating atpeak proficiency and that established goals are consistently being met.

  • Work is performed undertight deadlines.

  • Maintain effectivecommunication with patients, physicians, medical office staff and the HealthManagement facilities and departments.

  • Maintaining currentknowledge and understanding of government rules, regulations.

  • Ability to work withtechnology necessary to complete job effectively. This includes, but is notlimited to, SCI, phone technology, PULSE/DAR products, insurance verification /eligibility tools, patient liability estimation tools, and scanning technology.

  • Ability to perform allother duties as assigned or requested.


  • HighSchool graduate or equivalent

  • Minimumone (1) year experience as a Benefit Verification Specialist or equivalent

  • Knowledgeof CPT, HCPCS, ICD-9 and medical terminology

  • Excellentinterpersonal skills required to communicate with direct staff andinternal/external customers

  • Mustpossess excellent time management and organizational skills

Job: Business Office Support

Organization: Shared Services Center - Sarasota

Location: FL-Sarasota

Requisition ID: 1827216