Insurance Verification Representative OBGYN Clinic
Full Time
Lexington, KY 40509
Posted
Job description
Overview
CHI Saint Joseph Medical Group now part of CommonSpirit Health formed between Catholic Health Initiatives (CHI) and Dignity Health includes 275 providers delivering quality care to patients across 88 locations in central and eastern Kentucky. Our full service network delivers a variety of Primary Care Services including Family Internal Geriatric and Pediatric Medicine in addition to several specialties to deliver custom care based on the unique needs of our patients.
Responsibilities
Under general supervision, Insurance Verification Representative is responsible for verifying patient’s insurance information and obtains authorization prior to scheduled visits in accordance with HIPAA guidelines, internal standards and procedures, and other regulatory requirements. Responsible for interpreting coverage limitations, patient versus insurance coverage, follows up with payors/patients to secure account and responds to insurance verification questions. Work closely with physicians, patients, and other healthcare staffs to ensure authorizations cover the services needed and that correct information is obtained.
At CHI, we expect all our employees to live the values of Reverence, Integrity, Compassion and Excellence at work by:
Core CHI Behaviors: The following behaviors have been identified as critical to all staff roles at CHI:
Role-Specific Behaviors: these additional behaviors are necessary in the role:
Skills, Knowledge or Abilities critical to this role:
Qualifications
Pay Range
$15.00 - $18.87 /hour
CHI Saint Joseph Medical Group now part of CommonSpirit Health formed between Catholic Health Initiatives (CHI) and Dignity Health includes 275 providers delivering quality care to patients across 88 locations in central and eastern Kentucky. Our full service network delivers a variety of Primary Care Services including Family Internal Geriatric and Pediatric Medicine in addition to several specialties to deliver custom care based on the unique needs of our patients.
Responsibilities
- Job Summary / Job Purpose (briefly state why does this job exist in 3-5 lines)
Under general supervision, Insurance Verification Representative is responsible for verifying patient’s insurance information and obtains authorization prior to scheduled visits in accordance with HIPAA guidelines, internal standards and procedures, and other regulatory requirements. Responsible for interpreting coverage limitations, patient versus insurance coverage, follows up with payors/patients to secure account and responds to insurance verification questions. Work closely with physicians, patients, and other healthcare staffs to ensure authorizations cover the services needed and that correct information is obtained.
Key Responsibilities (list 5-8)
Ensure insurance coverage by telephone.- Resolve any issues with coverage and escalates complicated issues to manager.
- Interview patients and completes all paperwork necessary to ensure the admitting process is efficient and all clinic and regulatory policies are in compliance.
- Coordinate with clinical staff to obtain charge information for all patients.
- Code procedures performed and diagnosis on charge.
- Assign appropriate ICD-9, CPT and HCPCS code(s) to accurately support the need and documentation for each service.
- Coordinate copies of medical documentation with physician charges to support billing to third-party payers.
- Identify physician services provided, but not accurately documented in the medical record.
- Resolve routine patient billing inquiries and problems.
- Perform other duties as assigned.
CHI Core Expectations
At CHI, we expect all our employees to live the values of Reverence, Integrity, Compassion and Excellence at work by:
Honoring and caring for the dignity of all persons in mind, body, and spirit- Ensuring the highest quality of care for those we serve
- Working together as a team to achieve our goals
- Improving continuously by listening, and asking for and responding to feedback
- Seeking new and better ways to meet the needs of those we serve
- Using our resources wisely
- Understanding how each of our roles contributes to the success of CHI.
Core Job Competencies
Core CHI Behaviors: The following behaviors have been identified as critical to all staff roles at CHI:
Teamwork Orientation: works cooperatively & collaboratively with others toward the accomplishment of shared goals.- Service Orientation: desire to serve and focus one’s efforts on discovering and meeting the needs of internal and external customers.
- Achieves Results: reflects a drive to achieve and outperform. Continuously looking for improvements. Accepts responsibility for actions and results.
- Learning and Growth: has a commitment to continuous professional and organizational learning
- Communication: practices attentive and active listening and can restate opinions of others; communicates messages in a way that has the desired effect.
Role-Specific Behaviors: these additional behaviors are necessary in the role:
Thorough understanding of insurance payor reimbursement, collection practices, and accounts receivable follow-up required.- Broad knowledge of the content, intent and application of HIPAA, federal and state regulations.
- Understanding of insurance payor reimbursement and collection practices.
- Knowledge of insurance industry and basic medical terminology/abbreviations preferred.
- Understands health insurance and medical costs, including coding.
- Requires good customer skills.
- Good communication skills.
- Proficient computer skills.
- Possess a strong work ethic and a high level of professionalism.
Skills, Knowledge or Abilities critical to this role:
Language Ability: Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to common inquiries or complaints from groups of managers, clients, customers, and the general public.
Math Ability: Ability to add, subtract, multiply and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Computer Skills: Must be proficient with the Microsoft Office Suite, Internet navigation, database management, desktop publishing, spreadsheet, and graphic presentation packages.
Qualifications
- Job Requirements / Qualifications
Education / Accreditation / Licensure (required & preferred):
Bachelor degree in related field preferred.
Experience (required and preferred):
2 – 4 years healthcare experience preferred.
Pay Range
$15.00 - $18.87 /hour
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