Job Description

Insurance Verification Specialist (Remote) Location Pearland, TX :

Are you a value-driven and compassionate individual that believes in providing quality care that has positive effect on our communities? At Community Health Network, we are driven to create extraordinary experiences for our patients and employees. Our objective is to provide opportunities that develop and grow careers in a team-oriented environment focused on patient care.

SCOPE OF RESPONSIBILITIES:

The insurance verification specialist is responsible for verifying patient insurance

coverage, to ensure necessary services and procedures are covered by an individual's payor. Obtain all necessary authorizations or referrals for recommended services or procedures per payer requirements. File appeals, if necessary, for authorization requests that are initially denied. This position requires professionals to spend extensive amounts of time on the phone with insurance companies. He/ She is responsible for entering accurate data to ensure that the patients' insurance information is updated in the organization's practice management system and verify that existing information is correct. Also, he/she is documenting notes on the amount of payment (patient responsibility) that will need to be collected by front desk staff. Responsible for working with billing team members to direct follow-up resources to specific balance categories for different financial classes.

ESSENTIAL JOB DUTIES

• Eligibility: effectively and accurately verify and document active health insurance information and interpretation of benefits prior to service being rendered. Maintain patients' account information in E.HR system (IC-E) to reflect actual patients' benefit coverages.
• Prior Authorization/Referrals: effectively and accurate determine if prior authorization or referral is required by health insurance plans, request authorization contacting issuing provider and health plan. Ability to thoroughly follow up through finalization process and maintain active authorization in patient chart. Must have the ability to focus and work quickly, as insurance paperwork commonly needs to be processed in a timely manner.
• Communication: Must be able to explain coverage and benefits to patients so they can understand why some procedures may be covered, while others are not. The insurance verification specialist may also discuss different financing options to fit their budgets (ex: in-house programs for uninsured or underinsured patients). Must be able to educate verification/benefits to assist Patient Service Specialist on patient's responsibilities (copays, deductibles, etc.). Work with billing department with insurance questions or issues. Work with credentialing department as needed.
• Perform other duties as assigned by Revenue Cycle Manager.

PHYSICAL DEMANDS/WORK ENVIRONMENT

• BLOODBORNE PATHOGENS EXPOSURE LEVEL: 3 (LOW)

Physical Demands:

• Frequently required to sit.
• Frequently required to talk and stand
• Frequently required to utilize hand and finger dexterity.
• Specific frequently vision abilities required by this job include: Close vision, Color vision, Peripheral vision, Depth perception, and Ability to adjust focus.

MINIMUM JOB REQUIREMENTS/EDUCATION

• High school diploma or GED.
• Minimum 2-3 years in a medical facility.
• Familiar with medical, dental, and behavioral terminology.
• Extensive knowledge of different type of coverages and policies.
• Knowledgeable with patient EOB's.
• Familiarity with office equipment: computer keyboarding, calculators, photocopiers, and faxes.
• Ability to communicate clearly and effectively.
• Display strong detail-oriented skills with proven ability to multi-task.
• Ability to work with people of all socioeconomic levels.
• Strong team player with a focus on collaboration.
• Ability to respond effectively to the most sensitive inquiries or complaints.
• Must be organized, able to prioritize tasks and handle multiple projects accuracy and attention to detail is essential.
• Ability to create, and manage data with Microsoft Excel and other Microsoft software programs
• Consumer advocate for quality health care and services.

Putting Our Heart into Your Care MyCHN (Community Health Network) is a local healthcare provider dedicated to providing excellence in care and service. We currently operate in Brazoria, Harris, and Galveston counties. MyCHN (Community Health Network) is a healthcare organization with 14 locations throughout the greater Houston area that offers multiple services for whole-person care.

Benefits:

• Health insurance
• Dental insurance
• Vision insurance
• Paid time off
• 401(k)
• 401(k) matching
• Life insurance
• Other
• Flexible schedule
• Disability insurance
• Employee discount
• Mileage reimbursement

Job Type: fulltime

Education: High school degree

Work location: This is a remote position

Job Tags

Full time, Work at office, Local area, Remote work, Flexible hours,

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