Insurance Verification Clerk

New Mexico Surgery Center Multi-Specialty @ Presbyterian Rust Medical Center ASC is searching for a Insurance Verification Clerk for a Full-Time role.

JOB SUMMARY

Verifies insurance coverage based on information provided by physician offices at the time of scheduling.  Contacts patient to gather additional information, if needed, as well as to notify them of their financial responsibility prior to the scheduled date of service. 

Reviews financial obligation with patient and authorized party following USPI’s Surgicares program or any other program established by the company.  Pre-qualifies third party coverage of scheduled procedure(s).  Actively coordinates with materials management regarding required implants, equipment and/or supplies needed for scheduled cases in order to calculate allowable and patient responsibility accurately. 

Follows all policies and procedures.

THESE DUTIES ARE IN ADDITION TO ANY OTHER DUTIES ASSIGNED TO THE INDIVIDUAL BY MANAGEMENT. 

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:  Includes the following.  Other duties may be assigned by management.

Communication Responsibilities to include, but not limited to:

·         Provides payment arrangement documentation for surgical procedures to appropriate individuals

·         Maintains current materials, such as Care Credit brochures and forms, MedDraft forms, etc. for patient education, review and signature.

·         Discusses documentation with patient and family member confirming instructions are understood and questions answered

·         Answers patient and authorized party’s questions and refers questions to healthcare professionals when appropriate

·         Communicates pertinent information from physician, support staff, insurance companies and other significant parties to the patient

·         Reviews pre-qualification for third party payer before date of scheduled admission and contacts payer to ensure facility is covered for pre-certifications and pre-qualifications.

·         Verify Insurance Benefits and Determine patient responsibility based on Insurance Contract

Counsels patients about facility charges, insurance coverage, and patient responsibility. 

·         Discusses financial obligations with the patient or authorized party, explaining fees and reimbursement process

·         At patient request, provides a written explanation of estimated fee schedules prior to surgery and documents it in the patient’s medical record

·         Determines patient qualification for coverage by third party payer and informs patient or authorized party of status.  If patient is not covered, arranges for payment following company designated program

·         Assists in planning a payment schedule for the patient, if appropriate

·         Completes data entry of patient cost sheets, insurance verification forms, payment arrangement forms completely and accurately and assures any forms needing patient review and signature are provided to registration prior to the date of service

·         Obtains demographic information / surgical checklists from scheduling

·         Places calls to offices as needed to obtain and to ensure timely processing of verification

·         Performs insurance verification process and completes it with thorough documentation of benefits, patient information and any other financial information obtained.

·         Enters complete and accurate information into computer system, such as on verification button, in comments, in registration module, etc., so that mistakes are avoided, claims are clean and all information is available to all appropriate personnel

·         Verifies that procedures scheduled are procedures covered when performed in an ASC by the payer by checking Medicare and Medicaid fee schedules.

·         Uses all calculators available such as Medicare, workers compensation, out of network, etc., accurately

·         Calculates allowable as directed by management for all cases. 

·         Notifies management for approval when an out of network case, charity case, courtesy case, financial hardship case, or self-pay case is received prior to contacting patient.

Reports daily to management about current status of projects or workflow

Performs all other duties as assigned by management

KNOWLEDGE SKILLS AND OTHER REQUIREMENTS:

·         Ability to handle confidential information

·         Ability to set priorities and to work independently

·         Ability to interact in a positive manner with co-workers, supervisor and other facility employees

·         Ability to handle multiple tasks

·         Ability to enter data into computer, file large amounts of paper and use office equipment

·         Knowledge of how to access benefits from various sources such as phone, person, websites

·         Ability to interpret benefits in order to convey to patient and to calculate allowable

·         Ability to use discretion in dealing with the public 

·         Strong interpersonal skills

·         Ability to communicate patient benefits and payment options effectively and professionally

·         Ability to calculate allowable and patient responsibility accurately

·         Knowledge of medical terminology

The above statements are intended to describe the general nature and level of work being performed by individuals assigned to their job.  They are not intended to be an exhaustible list of all responsibilities, duties, knowledge, skills and abilities required of individuals so classified.

TOTAL EDUCATION, VOCATIONAL TRAINING AND EXPERIENCE

High school diploma or equivalent.  Previous experience in healthcare facility business office is desired.  Computer, office equipment skills are required.  Medical terminology required.