CommonSpirit Health Philanthropy
Responsibilities
Under general supervision, the Insurance Verification Representative is responsible for verifying patients' insurance information and obtaining authorization prior to scheduled visits, in accordance with HIPAA guidelines, internal standards, procedures, and other regulatory requirements. They interpret coverage limitations, coordinate with patients and payors, and respond to verification questions. The role involves working closely with physicians, patients, and healthcare staff to ensure coverage and accurate information. Verify insurance coverage via telephone. Resolve coverage issues and escalate complex cases to the manager. Interview patients and complete necessary paperwork to ensure efficient admitting processes and compliance with policies. Coordinate with clinical staff to obtain charge information. Code procedures and diagnoses accurately for billing purposes. Assign appropriate ICD-9, CPT, and HCPCS codes to support billing and documentation. Coordinate medical documentation with physicians to support third-party billing. Identify services provided but not documented in the medical record. Resolve routine billing inquiries and issues. Perform other duties as assigned. Qualifications
Required Education and Experience Bachelor's degree in a related field preferred. 2-4 years of healthcare experience preferred. Required Knowledge, Skills, Abilities, and Training Thorough understanding of insurance payor reimbursement, collection practices, and accounts receivable follow-up. Knowledge of HIPAA, federal and state regulations. Understanding of insurance reimbursement and collection practices. Knowledge of the insurance industry and medical terminology. Understanding of health insurance and medical coding. Good customer service skills. Effective communication skills. Proficient computer skills. Strong work ethic and professionalism. Overview
CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With over 700 care sites across the U.S., including clinics, hospitals, and community care, CommonSpirit is committed to building healthy communities and advocating for the vulnerable, innovating healthcare delivery inside and outside hospitals. #J-18808-Ljbffr
Under general supervision, the Insurance Verification Representative is responsible for verifying patients' insurance information and obtaining authorization prior to scheduled visits, in accordance with HIPAA guidelines, internal standards, procedures, and other regulatory requirements. They interpret coverage limitations, coordinate with patients and payors, and respond to verification questions. The role involves working closely with physicians, patients, and healthcare staff to ensure coverage and accurate information. Verify insurance coverage via telephone. Resolve coverage issues and escalate complex cases to the manager. Interview patients and complete necessary paperwork to ensure efficient admitting processes and compliance with policies. Coordinate with clinical staff to obtain charge information. Code procedures and diagnoses accurately for billing purposes. Assign appropriate ICD-9, CPT, and HCPCS codes to support billing and documentation. Coordinate medical documentation with physicians to support third-party billing. Identify services provided but not documented in the medical record. Resolve routine billing inquiries and issues. Perform other duties as assigned. Qualifications
Required Education and Experience Bachelor's degree in a related field preferred. 2-4 years of healthcare experience preferred. Required Knowledge, Skills, Abilities, and Training Thorough understanding of insurance payor reimbursement, collection practices, and accounts receivable follow-up. Knowledge of HIPAA, federal and state regulations. Understanding of insurance reimbursement and collection practices. Knowledge of the insurance industry and medical terminology. Understanding of health insurance and medical coding. Good customer service skills. Effective communication skills. Proficient computer skills. Strong work ethic and professionalism. Overview
CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With over 700 care sites across the U.S., including clinics, hospitals, and community care, CommonSpirit is committed to building healthy communities and advocating for the vulnerable, innovating healthcare delivery inside and outside hospitals. #J-18808-Ljbffr