Insurance Verification Specialist (on-site required)
Company: e CancerCare
Location: Garland
Posted on: January 25, 2023
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Job Description:
Job Purpose: The Specialist is responsible for insurance
verification processes of verifying patient eligibility,
coordinating medical benefits, gaining approval for planned
procedures and services, and determining patient coverage /
responsibility for services to be provided. Essential Functions:
Verify private, government and third party insurance information,
including eligibility, out-of-pocket costs, prescription coverage
and patient portions. Verify any secondary and tertiary medical
insurance benefits. Obtain, review and input insurance
authorization and referrals prior to patient services, and
throughout treatment to maintain continuance of authorizations.
Advocate for the patient utilizing knowledge of coverage based
guidelines and treatments. Provide accurate and timely estimated
patient responsibility amounts to patient service staff members.
Monitor and track patient authorizations, obtain updated
authorizations for ongoing treatment, and communicate changes to
appropriate team members. Identifies and provides accurate CPT/ICD
codes where needed for reimbursement. Maintain appropriate logs and
reports to professional, state and federal requirements; including
but not limited to Medicaid, Medicare, case logs and drug logs.
Obtains, interprets and submits clinical documentation pertinent to
the specific services requiring prior authorization to support
medical necessity reviews by the payer. Follows up on denied
authorization requests, escalates to appointed appeal personnel,
and relays the necessary denial detail to the provider to
facilitate the appeal and/or peer to peer reviews. Work closely
with Financial Counselor, Patient Navigator and front office staff
to ensure smooth collection process. Maintains appropriate
documentation in clinic systems and EMR. Other responsibilities as
required. Regular attendance and punctuality. Contributes to team
effort by accomplishing related results as needed. Ensures that all
processing and reporting deadlines are consistently achieved.
Perform any other functions as required by management.
Qualifications and Education Requirements Minimum of 2 years in
this field or related field such as medical coding, financial
counseling setting or similar service profession. Strong knowledge
of ICD9/10 diagnosis codes, as well as CPT codes. Must be
proficient using a computer, online websites, and email. Knowledge
of basic medical terminology Ability to work a flexible schedule
(including overtime, and weekends, as necessary). High school
graduate or equivalent Preferred Skills Previous oncology
background preferred Required Competencies Strong Business and
Organizational Competence. - Exceptional Customer Service Skills. -
Strong functional Competence. Interpersonal Skill Competency.
Stress Tolerance. Initiative. Adaptability. Accountability.
Integrity. Self-Confidence. Time Management Skills with an emphasis
on multi-tasking. Physical Demands and work environment The
physical demands and work environment characteristics described
here are representative of those that must be met by an employee to
successfully perform the essential functions of this job. -
Reasonable accommodations may be made to enable individuals with
disabilities to perform the essential functions. Physical demands:
Required job duties are essentially sedentary in nature, consisting
of occasional walking, standing, lifting and/or carrying ten pounds
maximum, seeing, speaking and hearing. Work environment: - Required
job duties are normally performed in a climate-controlled office
environment.
Keywords: e CancerCare, Garland , Insurance Verification Specialist (on-site required), Other , Garland, Texas
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