Summary: Under the general direction of the department manager, and in accordance with corporate goals, this position verifies all existing patient insurance information, documents, communicates and corrects billing system to reflect accurate coverage as per payor specifications and regulations. The position is essential to maximize revenue and reduce the number of uncollected account receivables.
Accurately enters, verifies and sequences all incoming referrals for Lifetime Care and all related entities. Adheres to time frames noted within policy to create an efficient and effective admission flow which includes proper documentation.
Accesses information from various sources including on line verification systems such as EPACES, IVANS and commercial payer websites and provider lines to access the most current information.
Re-verifies insurance for each open and active patient on service. Uses all systems as appropriate for the payor/insurance plan, on a monthly basis or as needed.
Consistently demonstrates high standards of integrity by supporting the Lifetime Healthcare Companies' mission and values and adhering to the Corporate Code of Conduct.
Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures.
Regular and reliable attendance is expected and required.
Performs other functions as assigned by management.
Level II Performs similar functions as level I, as well as:
Organizes the inquiries from Patient Financial Service Department staff as well as clinical staff to determine proper, accurate and timely sequencing of payors to insure accurate billing.
Researches and resolves issues resulting in necessary changes to patients' accounts and the liability for payment of services provided.
Accurately documents patient insurance information, determines proper sequence of coordination of benefits, clearly communicates to all departments and corrects billing system to reflect accurate coverage.
Contacts resources to resolve discrepancies in insurance information, including patients, physician's offices and County Department of Social Services (DSS) offices.
Communicates with peer nurses, team managers, and supervisors via telephone or e-mail to discuss case and the necessary steps that need to be taken in order for payment to occur.
Shares information and knowledge learned (with co-workers) while working in the various on-line systems with other departmental staff and management.
Works collaboratively with Home Care Coordinators and Insurance Coordination staff to rectify coordination of benefit issues.
Level III Performs other functions as level II, as well as:
Conducts research to obtain Medicare numbers when the patient is enrolled in a Medicare Advantage Plan and no Medicare number has been provided.
Performs analysis from existing systems, work flows and provides recommendations to improve efficiency.
Understands appropriate prioritization of issues and when to elevate problems to management.
We include multiple levels of classification differentiated by demonstrated knowledge, skills, and the ability to manage increasingly independent and/or complex assignments, broader responsibility, additional decision making, and in some cases, becoming a resource to others. In addition to using this differentiated approach to place new hires, it also provides guideposts for employee development and promotional opportunities.
High School Diploma or equivalent with a minimum of three years of experience in a related health care field.
Excellent organization, communication and customer service skills required for success.
Must be familiar with Microsoft Windows including Microsoft Office.
Attention to detail.
Levels II and III requires similar qualifications as level I, as well as:
Associate's degree in Business Administration or related certification/degree with a minimum of five years' experience in a related health care field.
Must have working knowledge of all types insurances including Medicare, Medicaid, HMO, Worker's Comp, No Fault and other Commercial Liability including pertinent regulations for billing.
Person must be able to work on computer 6-8 hours a day with excellent data entry and documentation skills.
The Lifetime Healthcare Companies aim to attract the best talent from diverse socioeconomic, cultural and experiential backgrounds, to diversify our workforce and best reflect the communities we serve.
Our mission is to foster an environment where diversity and inclusion are explicitly recognized as fundamental parts of our organizational culture. We believe that diversity of thought and background drives innovation which enables us to provide leading-edge healthcare insurance and services. With that mission in mind, we recruit the best candidates from all communities, to diversify and strengthen our workforce.
In support of the Americans with Disabilities Act, this job description lists only those responsibilities and qualifications deemed essential to the position.
Equal Opportunity Employer