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SalaryCompany Overview:
The Patient Insurance Specialist & Documentation Auditor is an active member of the O&P Billing Team that delivers support consistent with the strategic vision, goals, philosophy and direction of Shriners Children's organization and POPS. The Specialist/Documentation Auditor is responsible for determining the status of a patient's insurance eligibility/coverage by contacting the appropriate insurance or third party Payor in accordance with POPS policies and procedures. The Specialist/Documentation Auditor must have a thorough knowledge and understanding of Commercial, Managed Care, Medicaid, Managed Medicaid and Medicare payor guidelines and eligibility criteria. The Specialist/Documentation Auditor will physically be located at the Central Fabrication Center in Tampa, FL but will perform insurance verification for assigned hospitals located throughout the U.S.
Responsibilities:
Shriners Children’s is a family that respects, supports, and values each other. We are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience defines us as leaders in pediatric specialty care for our children and their families.
Job Overview: Shriners Children's is the premier pediatric burn, orthopaedic, spinal cord injury, cleft lip and palate, and pediatric subspecialties medical center. We have an opportunity for a Patient Insurance Specialist & Documentation Auditor based at our Central Fabrication Center based in Tampa, FL.
The Patient Insurance Specialist & Documentation Auditor is an active member of the O&P Billing Team that delivers support consistent with the strategic vision, goals, philosophy and direction of Shriners Children's organization and POPS. The Specialist/Documentation Auditor is responsible for determining the status of a patient's insurance eligibility/coverage by contacting the appropriate insurance or third party Payor in accordance with POPS policies and procedures. The Specialist/Documentation Auditor must have a thorough knowledge and understanding of Commercial, Managed Care, Medicaid, Managed Medicaid and Medicare payor guidelines and eligibility criteria. The Specialist/Documentation Auditor will physically be located at the Central Fabrication Center in Tampa, FL but will perform insurance verification for assigned hospitals located throughout the U.S.
The Specialist/Documentation Auditor is responsible for auditing Physician documentation and O&P documentation to ensure compliance with all State and Federal guideline, regulations, and payor requirements. The Specialist/Documentation Auditor is responsible for communication with Physicians and O&P practitioners to request additions and addendums to existing documentation when required, as well as having responsibility for communication with the Supervisor to discuss patterns, trends, or resistance to amending documentation when requested.
Responsibilities:
Responsibilities:
- Performs insurance verification and authorization functions for assigned POPS locations under the direction from the Billing and Contracts Manager
- Performs an audit of assigned documentation in Emergency Medical Record (EMR) with Audit Check List
Experience Required:
- 3 years of experience working as an insurance verifier and authorizer in an acute care hospital or Physician practice setting, or other healthcare setting, required
- 2 years of audit or billing experience required
- Microsoft Office proficiency (Word, Excel, PowerPoint, Outlook)
- High School Diploma/GED required
Experience Preferred:
- Insurance verification and authorization experience in a children's hospital preferred
- DME experience strongly preferred
Knowledge, Skills & Abilities:
- Demonstrated ability to communicate in writing and verbally and an effective manner - effective communication includes the ability to spell accurately and write legibly
- General familiarity with Electronic Medical Record (EMR) coding systems
- Functional knowledge of HCFC coding systems
- Working experience with audit processes and general knowledge of CMS and/or State Medicaid as well as other regulatory bodies
- Strong organization, prioritization, and detail orientation skills are critical for this role
