Community Health Systems Insurance Verify Rep in Sarasota, Florida
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 physicians 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.
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
Requisition ID: 1825165