Insurance Verification Specialist FT

Roswell Surgery Center is seeking a strong business partner in the role of an insurance verification specialist. This health care business professional will be assigned to working to ensure that patients' health care benefits cover required procedures. They will be responsible for contacting a patient's insurance company to verify coverage levels and works with individuals to educate them on their benefits information. This role serves as a valued member of the health care team, helping patients get the medical procedures they need.

The Insurance Verification Clerk is responsible for validating and entering patient information and insurance coverage into the appropriate computer system. Duties may also include communicating with physician offices, insurance carriers, and patient follow-ups.

JOB SUMMARY: Verify Insurance Benefits and Determine Co-pay based on Insurance Contract.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

• Review Patient information.

• Begin chart and pre-admission process.

• Verify insurance benefits by reviewing our contract and patient's quoted benefits. Determine co-pay. Post all insurance and billing comments, to include requests by BOM. Enter all information into patient accounting system....time and date

• Contact patients regarding money due prior to the date of surgery.

• Contact patients of their financial responsibility in the timeliest manner that coincides with providing excellent patient experience.

• Knowledgeable of the Managed Care contract and knowledgeable of the updates

OTHER DUTIES AND RESPONSIBILITIES:

• As Assigned by Business Office Manager.

• Participate in USPI EDGE program.

• Crossed trained to efficiently cover and relieve front desk for lunches and staffing purposes.

• During downtime assist in Collection Calls, assist in research for the Collection Specialist.

• Enter all PHI information into system before the end of each Business day.

Required Skills:

Required Skills:

KNOWLEDGE, SKILLS, QUALIFICATION and EDUCATIONAL AND /OR EXPERIENCE REQUIREMENTS:

High school diploma or equivalent. One to three months of related experience and/or training. Or Equivalent combination of education and experience.

Communication skills: ability to effectively present information to patients, physicians, and other employees of surgery center.

Basic math skills.

PHYSICAL DEMANDS / WORKING CONDITIONS:

The working environment is representative of the essential functions of the job. Physical demands require employee to sit and answer the phone for extended periods of time. Reasonable accommodations may be made to enable individuals to perform essential functions.

OTHER:

• Set up new pay sources as required.

• Change contracts as determined by insurance verification.

• Review ALL self-pay and Indigent /Charity accounts with BOM.

• Weekly/daily review all accounts to ensure authorizations were obtained to proceed with procedures and document in the Patient accounting system.

• Email physician teams to ensure authorizations are on file.

• Employed at a doctor's office or ASC for minimum of 12 months
• Working Knowledge of Managed Care contracts and how they work
• Ability to verbalize the knowledge of Managed Care Contracts
• Working knowledge for manually calculating insurance allowed amounts and patient responsibility
• Working knowledge and comprehension of EOB's (Explanation of Benefits)

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Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
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