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
Requisition ID: 1827216