Benefit Verification Specialist - RSC / Mississippi
Location: Flowood Mississippi
Description: Health Management Associates is currently seeking to employ Benefit Verification Specialist - RSC / Mississippi right now, this occupation will be placed in Mississippi. More complete informations about this occupation opportunity please read the description below. ESSENTIAL JOB FUNCTIONS:
Provide professional, accurate, timely insurance verification and! notification for outpatient diagnostic services, observation and inpatient services
Responsible for the timely verification of medical insurance benefits for the service scheduled or service being provided via website and/or calling the payor (Managed Care payors, Governmental payors and Commercial payors)
Verifies insurance eligibility, benefits and preauthorization/precertification/referral guidelines following the 16 components of verification
Meets all required standards for assuring thorough documentation of the 16 components of insurance verification where applicable based on payor
Ensure all account activity is documented in the computer system timely and thoroughly
Using payor websites and documentation provided by the physician’s office determine if the scheduled service is medically necessary based on payor guidelines by CMS and commercial payors
Working knowledge of Medical Necessity protocols for scheduled! tests and procedures and notifies physician office of any tes! ts that do not meet necessity guidelines
Communicates and educates patients and physician practices to ensure compliance with identified payor requirements as needed
Validates that all necessary referrals, pre-certification and/or authorizations for scheduled service are on file and that they are valid for the scheduled test being performed
Reviews and resolves preauthorization/precertification/referral issues that are not valid and contacts insurance carriers to verify/validate requirements to ensure accuracy and avoid potential denial and contact ordering physician office if necessary to have authorization submitted
Calculates patient estimated portions via estimation tool and contacts patient prior to the scheduled appointment to notify patient of their patient responsibility
Notify Benefit Verification Manager immediately when uninsured or underinsured patients are identified
Responsible for maintaining performance s! tandards that ensure the department is operating at peak proficiency and that established goals are consistently being met
Work is performed under tight deadlines
Maintain effective communication with patients, physicians, medical office staff and the Health Management facilities and departments
Maintaining current knowledge and understanding of government rules, regulations.
Ability to work with technology necessary to complete job effectively. This includes, but is not limited to, SCI, phone technology, PULSE/DAR products, insurance verification / eligibility tools, patient liability estimation tools, and scanning technology
Ability to perform all other duties as assigned or requested
Job Requirements
EDUCATION, SKILLS & EXPERIENCE:
High School graduate or equivalent
Minimum one (1) year experience in a medical facility, ambulatory surgery facility, or acute-care hospital working with insur! ance verification
Knowledge of CPT, HCPCS, ICD-9 and medical t! erminology
Excellent interpersonal skills required to communicate with direct staff and internal/external customers
Must possess excellent time management and organizational skills
Facility
RSC - Mississippi
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If you were eligible to this occupation, please email us your resume, with salary requirements and a resume to Health Management Associates.
If you interested on this occupation just click on the Apply button, you will be redirected to the official website
This occupation starts available on: Thu, 18 Apr 2013 21:06:46 GMT
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