Insurance Verifier, Full Time, Days - Steward Health Care System
Hialeah, FL 33013
About the Job
Responsible for performing the appropriate processes to verify patient eligibility, coordinate benefits, ensure insurance coverage, and determine if prior authorization is needed for said order. If needed, obtains authorization and documents in the patient electronic medical record. Facilitates responses to patient inquiries regarding authorizations within turnaround standards.
For more information, visit https://pm.healthcaresource.com/cs/steward/#/job/139475
KEY RESPONSIBILITIES:
- Verifies member eligibility and benefits.
- Inputs all referral requests into system accurately for electronically generated authorization tracking.
- Requests submission of appropriate medical records according to established criteria for requested service(s).
- Issues authorization within appropriate timeframe for routine, urgent and emergent requests.
- Appropriately forwards all referral requests to the next level of review.
- Coordinates approved outpatient procedures with health plan's authorization department when applicable.
- Distributes correspondence and other information to the appropriate parties or departments.
- Documents and communicates areas of concern to supervisor.
- Identifies providers who are problematic with plan requirements.
- Adheres to company HIPAA policies and procedures.
- Ensures integrity of data entry is accurate.
REQUIRED KNOWLEDGE & SKILLS:
- Medical terminology, Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS)/International Classification of Diseases (ICD)-9 coding knowledge.
- Knowledge of medical terminology/anatomy.
- Ability to exercise discretion and make independent judgments, seeking review when decisions represent significant departure from established guidelines.
- Knowledge of Microsoft Office programs including Excel, Word or similar programs.
- Ability to maintain composure during challenging interpersonal interactions.
- Active listening skills; including interpersonal skills and telephone communication.
- Organizational skills with attention to detail and follow-up.
EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:
Education: High School Diploma or equivalent education/experience
Experience (Type & Length): One year within a health care setting
Software/Hardware: Meditech
License/Certification: Other: None