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SalaryThis position is remote. The working hours are 8:00am - 4:30pm CST.
Summary: The Benefit Verification Specialist – Outpatient, under the direction of the Benefits Manager or Supervisor, verifies benefit coverage, performs medical necessity verification, and determines estimated patient financial responsibility for scheduled outpatient services. This position will support our Shared Services Center and client hospitals around the country for a wide variety of payors, service lines, and patient types by providing top-notch support to the entire revenue cycle.
Essential Duties and Responsibilities: (List in order of importance or percentage of time spent on the particular responsibility. High to Low)
- Provide professional, accurate, timely insurance verification and notification for outpatient diagnostic, observation, and inpatient services. (40%)
- Document all account activity in the applicable host system timely and thoroughly. (10%)
- Use web applications and documentation provided by the physician’s office to determine if the scheduled service is medically necessary, based on payor guidelines by CMS and commercial payors, and notifies physician office or appropriate department of any tests that do not meet medical necessity guidelines. (10%)
- Calculate patient estimated portions via estimation tool. (10%)
- Responsible for maintaining performance standards that ensure the department is operating at peak proficiency and that established goals are consistently being met while maintaining effective communication with physicians, medical office staff, facilities, and departments. (10%)
- Works with technology necessary to complete job effectively. This includes, but is not limited to, phone technology, applicable host systems, web applications, and scanning technology. (10%)
- Performs all other duties, as assigned or requested, while adhering to strict deadlines. (10%)
Qualifications:
Required Education: High School Diploma or Equivalent
Required Experience: 1+ years of medical office or healthcare facility experience
Required License/Registration/Certification: None
Preferred License/Registration/Certification: Certified Professional Coder (CPC)
Reasoning Ability:
Ability to define problems, collect data, establish facts and draw valid conclusions. Ability to interpret an extensive variety of payer requirements and medical necessity responses.
Computer Skills Required:
To perform this job successfully, an individual should have knowledge of host systems, ancillary applications, and payor web applications.
Physical Demands:
In order to successfully perform this job, with or without a reasonable accommodation, the following are outlined below:
The Employee is required to read, review, prepare and analyze written data and figures, using a pc or similar and should possess visual acuity.
The Employee may be required to occasionally climb, push, stand, walk, reach, grasp, kneel, stoop, and/or perform repetitive motions.
The Employee is not substantially exposed to adverse environmental conditions and therefore job functions are typically performed under conditions such as those found in general office or administrative work.
Education
Required- High School or better
