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Position at Renaissance Medical Foundation
POSITION SUMMARY:
This position will serve as a subject matter expert in insurance carrier requirements and referral knowledge to Physicians, Office Manager and others on a daily basis. This position will also determine insurance eligibility; provide referrals to other physicians and ancillary services for any patient of the office. It will call third party payers to obtain insurance benefits which include the effective dates of coverage, billing address, pre-existing condition clauses, in and out of network benefits and maximum coverage, as needed.
POSITION EDUCATION/ QUALIFICATIONS:
•High School Diploma/ GED is preferred
•Comprehensive understanding insurance benefits, referral requirements, reimbursement and medical terminology
•Excellent customer service skills, required
•Ability to work with geriatric patients in a high volume fast paced practice
•Computer skills required with knowledge of Microsoft Office suite, and the internet
•Excellent written and verbal communication skills required
•Bilingual - English/Spanish - preferred
JOB KNOWLEDGE/EXPERIENCE:
•Minimum of 2 years of insurance verification/referral experience is required, physician office experience preferred
•Communicates clearly and concisely via phone and is able to work effectively with other employees, providers, patients and external parties
•Medical Terminology, ICD and CPT Codes, HCPCS code, knowledge preferred
•Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly
•Requires reasoning ability, good independent judgment and organizational skills
•Requires working with frequent interruptions
•Must project a professional image
POSITION RESPONSIBILITES:
•Serves as a daily resource for all questions from providers, management and staff
•Appropriately monitors and verify benefits on all accounts requiring referrals on a daily basis
•Assists billing staff with researching accounts with discrepancies in payments to ensure appropriate payer reimbursement
•Handles calls and questions from patients, physicians, ins. carriers and ancillary providers with questions concerning referrals
•Confirms billing address, in and out of network benefits and maximum coverage for pt. procedures
•Uses knowledge of ins. carrier requirements to give appropriate information to each carrier, ex. MCR vs. MCD, vs. Health Spring when requesting benefit information.
•Reviews and confirms patient's financial information by obtaining the insurance carrier information, benefit information, policy number, group name, group number, effective date of coverage, and claim address
•Ability to reference ICD-9-CM/ ICD-10-CM, CPT from doctor's order to insurance carrier
•Reviews and confirms patient's deductibles, co-pays, and co-insurance on patients account
•Ability to identify the appropriate coordination of benefits for insurance carrier
•Utilizes phone and on-line verification systems, i.e. TMHP, Avility, Customer Kiosk and insurance carrier portals for eligibility, benefits and admission authorization submission
•Ensures referral/pre-authorization/pre-certification requirements have been met in a timely manner
•Verifies that the appropriate insurance carrier is assigned to the account and notes changes for reception staff for correction
•Reviews physician order for appropriate patient status (Inpatient/Outpatient) before verifying coverage for procedure
•Enter appropriate notes in the patient accounting system by documenting clearly and concisely all patient benefit information
•Communicates information about scheduled case, procedure, referral to office personnel involved, as needed
•Accurately performs basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly
•Uses knowledge of procedures to review and coordinate the correct diagnosis with procedures for each patient referral received
•Receives faxed auths from ins. carriers and MD offices, hospitals and other specialists to ensure continuation of care to other services for clinic patients
•Calls patients to inform them of their referral appointments and arranges for the authorization to get to the patient prior to the appointment
•Calls with patient on the line to change the PCP provider for managed Medicaid as needed
•Meets with MD on patients with financial issues for in-house procedures required, as needed
•Arranges for peer to peer reviews for insurance coverage/authorization as needed
•Provides medical records release of information for patients as needed
•Demonstrates proficiency of computer and practice software as required
•Ensures patient confidentiality requirements are met in accordance with policies and procedures
•Report any/all equipment failures to Supervisor and Administrator
•Other duties as assigned
Position at Renaissance Medical Foundation
POSITION SUMMARY:
This position will serve as a subject matter expert in insurance carrier requirements and referral knowledge to Physicians, Office Manager and others on a daily basis. This position will also determine insurance eligibility; provide referrals to other physicians and ancillary services for any patient of the office. It will call third party payers to obtain insurance benefits which include the effective dates of coverage, billing address, pre-existing condition clauses, in and out of network benefits and maximum coverage, as needed.
POSITION EDUCATION/ QUALIFICATIONS:
•High School Diploma/ GED is preferred
•Comprehensive understanding insurance benefits, referral requirements, reimbursement and medical terminology
•Excellent customer service skills, required
•Ability to work with geriatric patients in a high volume fast paced practice
•Computer skills required with knowledge of Microsoft Office suite, and the internet
•Excellent written and verbal communication skills required
•Bilingual - English/Spanish - preferred
JOB KNOWLEDGE/EXPERIENCE:
•Minimum of 2 years of insurance verification/referral experience is required, physician office experience preferred
•Communicates clearly and concisely via phone and is able to work effectively with other employees, providers, patients and external parties
•Medical Terminology, ICD and CPT Codes, HCPCS code, knowledge preferred
•Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly
•Requires reasoning ability, good independent judgment and organizational skills
•Requires working with frequent interruptions
•Must project a professional image
POSITION RESPONSIBILITES:
•Serves as a daily resource for all questions from providers, management and staff
•Appropriately monitors and verify benefits on all accounts requiring referrals on a daily basis
•Assists billing staff with researching accounts with discrepancies in payments to ensure appropriate payer reimbursement
•Handles calls and questions from patients, physicians, ins. carriers and ancillary providers with questions concerning referrals
•Confirms billing address, in and out of network benefits and maximum coverage for pt. procedures
•Uses knowledge of ins. carrier requirements to give appropriate information to each carrier, ex. MCR vs. MCD, vs. Health Spring when requesting benefit information.
•Reviews and confirms patient's financial information by obtaining the insurance carrier information, benefit information, policy number, group name, group number, effective date of coverage, and claim address
•Ability to reference ICD-9-CM/ ICD-10-CM, CPT from doctor's order to insurance carrier
•Reviews and confirms patient's deductibles, co-pays, and co-insurance on patients account
•Ability to identify the appropriate coordination of benefits for insurance carrier
•Utilizes phone and on-line verification systems, i.e. TMHP, Avility, Customer Kiosk and insurance carrier portals for eligibility, benefits and admission authorization submission
•Ensures referral/pre-authorization/pre-certification requirements have been met in a timely manner
•Verifies that the appropriate insurance carrier is assigned to the account and notes changes for reception staff for correction
•Reviews physician order for appropriate patient status (Inpatient/Outpatient) before verifying coverage for procedure
•Enter appropriate notes in the patient accounting system by documenting clearly and concisely all patient benefit information
•Communicates information about scheduled case, procedure, referral to office personnel involved, as needed
•Accurately performs basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly
•Uses knowledge of procedures to review and coordinate the correct diagnosis with procedures for each patient referral received
•Receives faxed auths from ins. carriers and MD offices, hospitals and other specialists to ensure continuation of care to other services for clinic patients
•Calls patients to inform them of their referral appointments and arranges for the authorization to get to the patient prior to the appointment
•Calls with patient on the line to change the PCP provider for managed Medicaid as needed
•Meets with MD on patients with financial issues for in-house procedures required, as needed
•Arranges for peer to peer reviews for insurance coverage/authorization as needed
•Provides medical records release of information for patients as needed
•Demonstrates proficiency of computer and practice software as required
•Ensures patient confidentiality requirements are met in accordance with policies and procedures
•Report any/all equipment failures to Supervisor and Administrator
•Other duties as assigned
