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Job Details

Insurance Verify Rep

Company name
Community Health Systems, Inc.

Location
Sarasota, FL

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Insurance Verify Rep

Community Health Systems

Sarasota

FL

Job #662509485

Description:

Provideprofessional, accurate, timely insurance verification and notification foroutpatient diagnostic services, observation and inpatient services.

Responsiblefor the timely verification of medical insurance benefits for the servicescheduled or service being provided via website and/or calling the payor (ManagedCare payors, Governmental payors and Commercial payors)

Verifiesinsurance eligibility, benefits and preauthorization/ precertification/ referralguidelines following the 16 components of verification

Meetsall required standards for assuring thorough documentation of the 16 componentsof insurance verification where applicable based on payor

Ensureall account activity is documented in the computer system timely and thoroughly

Usingpayor websites and documentation provided by the physicians office determineif the scheduled service is medically necessary based on payor guidelines byCMS and commercial payors

Workingknowledge of Medical Necessity protocols for scheduled tests and procedures andnotifies physician office of any tests that do not meet necessity guidelines

Communicatesand educates patients and physician practices to ensure compliance withidentified payor requirements as needed

Validatesthat all necessary referrals, pre-certification and/or authorizations forscheduled service are on file and that they are valid for the scheduled testbeing performed

Reviewsand resolves preauthorization/precertification/referral issues that are notvalid and contacts insurance carriers to verify/validate requirements to ensureaccuracy and avoid potential denial and contact ordering physician office ifnecessary to have authorization submitted

Calculatespatient estimated portions via estimation tool and contacts patient prior tothe scheduled appointment to notify patient of their patient responsibility

NotifyBenefit Verification Manager immediately when uninsured or underinsuredpatients are identified

Responsiblefor maintaining performance standards that ensure the department is operatingat peak proficiency and that established goals are consistently being met.

Workis performed under tight deadlines.

Maintaineffective communication with patients, physicians, medical office staff and theHealth Management facilities and departments.

Maintainingcurrent knowledge and understanding of government rules, regulations.

Abilityto work with technology necessary to complete job effectively. This includes,but is not limited to, SCI, phone technology, PULSE/DAR products, insuranceverification / eligibility tools, patient liability estimation tools, and scanningtechnology.

Abilityto perform all other duties as assigned or requested.

Qualifications

High School graduate or equivalent

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-9 and medical terminology

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

Must possess excellent time management and organizational skills

Job:

Business Office Support

Organization:

Shared Services Center - Sarasota

Location:

FL-Sarasota

Requisition ID:

1822986

Updated 05/10/2018

Company info

Community Health Systems, Inc.
Website : http://www.chs.net

Company Profile
Community Health Systems is founded with the first purchase of a hospital in May 1985. The second hospital purchase took place soon thereafter in January 1986. 1991: The company issues its initial public offering. June 1996: An affiliate of Forstmann Little & Co. acquires the company in a $1.1 billion leveraged buyout. Month 1997: Wayne T. Smith is recruited as President and Chief Executive Officer, adding Chairman of the Board Responsibilities in 2001. His appointment as CEO begins a period of exponential growth through acquisitions and improved operations. June 2000: Community Health Systems, Inc. is taken public for the second time on the New York Stock Exchange trading under the symbol CYH with an initial offering price of $13 per share. July 2007: Community Health Systems, Inc. completes the acquisition of Triad Hospitals, Inc. adding more than 50 hospitals and nearly doubling the size of the organization. The acquisition includes subsidiary Quorum Health Resources, LLC (QHR), a hospital management and consulting company with approximately 150 independent community hospital clients. January 2014: Community Health Systems, Inc. completes the acquisition of Health Management Associates, Inc., adding approximately 70 hospitals to the organization.

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