Insurance Verification Rep- Primary Care
Full Time
Winchester, KY 40391
Posted
Job description
Overview
CHI Saint Joseph Medical Group now part of CommonSpirit Health formed between Catholic Health Initiatives (CHI) and Dignity Health includes 275 providers delivering quality care to patients across 88 locations in central and eastern Kentucky. Our full service network delivers a variety of Primary Care Services including Family Internal Geriatric and Pediatric Medicine in addition to several specialties to deliver custom care based on the unique needs of our patients.
Responsibilities
JOB SUMMARY / PURPOSE
Under general supervision, Insurance Verification Representative is responsible for obtaining authorization prior to scheduled visits in accordance with HIPAA guidelines, internal standards and procedures, and other regulatory requirements. Responsible for interpreting coverage limitations, patient versus insurance coverage, follows up with payors/patients to secure account and responds to authorization and denial questions. Works closely with physicians,
patients, and other healthcare staffs to ensure authorizations cover the services needed and that correct information is obtained.
ESSENTIAL KEY JOB RESPONSIBILITIES
1. Ensure authorizations are completed prior to patient treatment.
2. Resolve any issues with coverage or eligibility and escalates complicated issues to manager.
3. Tracks expiring authorizations and changed treatment plans to ensure the patient is covered for the entirety of their treatment.
4. Coordinate with clinical staff to obtain charge information for all patients.
5. Assign appropriate authorization confirmations and dates to accurately support the need and documentation for each service.
6. Coordinate copies of medical documentation with physician charges to support billing to third-party payers.
7. Works with registration, financial counseling, etc. to ensure the patient receives authorizations in a timely manner.
8. Other duties as assigned by management.
Qualifications
MINIMUM QUALIFICATIONS
Required Licensure and Certifications- Does not apply
PREFERRED Qualifications
CHI Saint Joseph Medical Group now part of CommonSpirit Health formed between Catholic Health Initiatives (CHI) and Dignity Health includes 275 providers delivering quality care to patients across 88 locations in central and eastern Kentucky. Our full service network delivers a variety of Primary Care Services including Family Internal Geriatric and Pediatric Medicine in addition to several specialties to deliver custom care based on the unique needs of our patients.
Responsibilities
JOB SUMMARY / PURPOSE
Under general supervision, Insurance Verification Representative is responsible for obtaining authorization prior to scheduled visits in accordance with HIPAA guidelines, internal standards and procedures, and other regulatory requirements. Responsible for interpreting coverage limitations, patient versus insurance coverage, follows up with payors/patients to secure account and responds to authorization and denial questions. Works closely with physicians,
patients, and other healthcare staffs to ensure authorizations cover the services needed and that correct information is obtained.
ESSENTIAL KEY JOB RESPONSIBILITIES
1. Ensure authorizations are completed prior to patient treatment.
2. Resolve any issues with coverage or eligibility and escalates complicated issues to manager.
3. Tracks expiring authorizations and changed treatment plans to ensure the patient is covered for the entirety of their treatment.
4. Coordinate with clinical staff to obtain charge information for all patients.
5. Assign appropriate authorization confirmations and dates to accurately support the need and documentation for each service.
6. Coordinate copies of medical documentation with physician charges to support billing to third-party payers.
7. Works with registration, financial counseling, etc. to ensure the patient receives authorizations in a timely manner.
8. Other duties as assigned by management.
Qualifications
MINIMUM QUALIFICATIONS
Required Licensure and Certifications- Does not apply
Required education- High School diploma or transcript
PREFERRED Qualifications
- 2 to 4 years healthcare experience preferred
- Bachelor degree in related field preferred
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