Remote Medical Benefit Verification Specialist - Tucson

Job Description

This position is remote.

The orientation hours at 8:00am

• 4:30pm CST for the first 2 weeks.

The training hours are 8:00AM-4:30PM AZ MST/ 10:00AM-6:30PM CST for 3 months.

The working hours are 8:00am-4:30pm AZ MST / 10:00am CST - 6:30pm CST.

If you are a creative and flexible problem-solver who wants to be an advocate for our patients and be part of a passionate team in a dynamic industry, this job is for you.

Rewards for Doing Work That Matters

• What's in it for you:

• Starting pay: $15.50/hr-$18/hr

• Cash bonuses (based on facility performance) up to $750.00 per quarter

• Health Insurance Benefits (Medical, Dental, Vision, Flexible Spending Account, Short and Long Term Disability)

• Paid vacation days

• Paid sick leave

• 6 paid holidays plus two personal holidays

• Extra perks and discounts (discounts for shopping and entertainment, tuition reimbursement, adoption reimbursement, Employee Assistance Program)

• Promotional opportunities

• An employee-friendly environment focused on patient satisfaction

ESSENTIAL JOB FUNCTIONS:

• Provide professional, accurate, timely insurance verification and notification for outpatient diagnostic services, observation and inpatient services.

• Responsible for the timely verification of medical insurance benefits for the service scheduled or service being provided via website and/or calling the payor (Managed Care payors, Governmental payors and Commercial payors)

• Verifies insurance eligibility, benefits and preauthorization/precertification/referral guidelines following the 16 components of verification

• Meets all required standards for assuring thorough documentation of the 16 components of insurance verification where applicable based on payor

• Ensure all account activity is documented in the computer system timely and thoroughly

• Using payor websites and documentation provided by the physician's office determine if the scheduled service is medically necessary based on payor guidelines by CMS and commercial payors

• Working knowledge of Medical Necessity protocols for scheduled tests and procedures and notifies physician office of any tests that do not meet necessity guidelines

• Communicates and educates patients and physician practices to ensure compliance with identified payor requirements as needed

• Validates that all necessary referrals, pre-certification and/or authorizations for scheduled service are on file and that they are valid for the scheduled test being performed

• Reviews and resolves preauthorization/precertification/referral issues that are not valid and contacts insurance carriers to verify/validate requirements to ensure accuracy and avoid potential denial and contact ordering physician office if necessary to have authorization submitted

• Calculates patient estimated portions via estimation tool and contacts patient prior to the scheduled appointment to notify patient of their patient responsibility

• Notify Benefit Verification Manager immediately when uninsured or underinsured patients are identified

• Responsible for maintaining performance standards that ensure the department is operating at peak proficiency and that established goals are consistently being met.

• Work is performed under tight deadlines.

• Maintain effective communication with patients, physicians, medical office staff and the Health Management facilities and departments.

• Maintaining current knowledge and understanding of government rules, regulations.

• Ability to work with technology necessary to complete job effectively. This includes, but is not limited to, SCI, phone technology, PULSE/DAR products, insurance verification / eligibility tools, patient liability estimation tools, and scanning technology.

• Ability to perform all other duties as assigned or requested.

EDUCATION, SKILLS & EXPERIENCE:

Education:

High School graduate or equivalent

Experience:

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-10 and medical terminology

Administrative Skills:

• Excellent interpersonal skills required to communicate with direct staff and internal/external customers.

• Must possess excellent time management and organizational skills.

• Demonstrated critical thinking, creativity, problem solving and decision-making skills.