Job Description Summary:

This position is responsible for assuring insurance eligibility, benefit eligibility and patient liability estimation to prevent denials or penalties from insurance companies. Documents accurate insurance information and payment details in order to optimize reimbursement and to prevent potential write-offs. Maintains strong working knowledge of insurance plans, contract requirements and resources to consistently facilitate appropriate insurance verification.

This position offers full-time remote work. To be eligible, you must reside in one of the following states:  Arkansas, Arizona, Colorado, Florida, Hawaii, Idaho, Illinois, Indiana, Kansas, Michigan, Missouri, Montana, Minnesota, New Mexico, North Carolina, Ohio, Oregon, South Dakota, Tennessee, Texas, Virginia, Washington,  or Wyoming.

Qualifications:

• Minimum of two (2) years’ work experience in registration, financial clearance or patient financial services with strong working knowledge of healthcare insurance and benefit programs required. Associate’s or Bachelor’s degree preferred.
• Excellent knowledge of applicable rules and guidelines governing traditional insurance coverage and reimbursement required.
• Strong math and analytic skills required.
• Possess and maintain computer skills to include working knowledge of Microsoft Office Suite required.  Possess ability to learn other software as needed.
• Strong working knowledge of applicable rules, regulations and guidelines governing managed care coverage and reimbursement preferred.
• Background knowledge and understanding in medical terminology and medical coding preferred.
• Excellent organizational skills, detail-oriented, a self-starter, possess critical thinking skills and be able to set priorities and function as part of a team as well as independently.
• Commitment to working in a team environment and maintaining confidentiality as needed.
• Excellent verbal and written communication skills including the ability to communicate effectively with various audiences.
• Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy.

Job Specific Duties:

• Obtains reports needed to begin insurance verification processes that are outside of Meditech Worklists.
• Confirms eligibility and secures full benefits coverage information with insurance companies and employers. Confirms demographic information is correct and assures coordination of benefits (COBs) and insurance plan codes are accurate.
• Verifies Medicare accounts, cross-referencing traditional Medicare and other providers as required. Determines number of prior Medicare days and reviews system to determine appropriate status. Notifies the physician office if the admit status needs to be changed.
• Verifies insurance coverage for inpatient and outpatient accounts per department protocol.
• Determines pre-certification or referral requirements per department protocol.
• Communicates with provider regarding out of network barriers and documents accordingly.
• Calculates, communicates, and collects the patient liability prior to service. Conducts all transactions consistent with cash management policies and procedures.
• Maximizes collection of money by estimating patient liabilities and requesting collection of co-payments and other personal balances per department protocol.
• Assures accounts are distinguished and handled appropriately per department protocol. Furnishes needed documentation to the appropriate stakeholders in order to obtain approval.
• Reviews, follows up, and rectifies accounts held due to claim edits to ensure timely submission for billing. 
• Partners with Authorization team members to obtain authorization and referrals from payer. Completes documentation as required for coordination of care and patient account management. 
• Maintains compliance with HIPAA regulations as it pertains to the insurance process.
• Develops and maintains knowledge and skills to identify insurance plans correctly in the system, understands contract requirements and maintains accurate insurance information.
• Maintains professional development to remain up-to-date on insurance rules, regulations and changes within the industry.

The above essential functions are representative of major duties of positions in this job classification.  Specific duties and responsibilities may vary based upon departmental needs.  Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job.  Not all of the duties may be assigned to a position.

Maintains regular and consistent attendance as scheduled by department leadership.

Shift:

Day Shift - 8 Hours (United States of America)

Schedule Details:

Please know schedules and shifts are subject to change based on patient care and department/organizational needs.

Schedule:

Logan Health operates 24 hours per day, seven days per week.  Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed.

Notice of Pre-Employment Screening Requirements

If you receive a job offer, please note all offers are contingent upon passing a pre-employment screening, which includes:

• Criminal background check

• Reference checks

• Drug Screening

• Health and Immunizations Screening

• Physical Demand Review/Screening

Equal Opportunity Employer

Logan Health is an Equal Opportunity Employer (EOE/AA/M-F/Vet/Disability). We encourage all qualified individuals to apply for employment. We do not discriminate against any applicant or employee based on protected veteran status, race, color, gender, sexual orientation, religion, national origin, age, disability or any other basis protected by applicable law. If you require accommodation to complete the application, testing or interview process, please notify Human Resources.