National Health Care Solutions
ABOUT US
We are a dynamic enterprise group of managed care and health insurance service companies which have become industry leaders in their diverse specialties. Headquartered in Dallas, Texas, the group has 10 offices around the world, including the United States, Canada, Panama, Ecuador, Colombia, and Dubai, and employs over 700 employees of various nationalities.
DUTIES AND RESPONSIBILITIES
The essential functions include, but are not limited to the following:.
Essential Duties Completes accurate and timely insurance verification, comparing Diagnostic and procedures against policy provision to determined compensability of the service Completes accurate and timely TAT authorization requests (evaluation of emergency or same-day/next-day services, evaluation of non-emergency or scheduled services, evaluation and negotiation of medical fees, evaluation of extensions, extended hospitalizations), including ensuring all necessary data elements needed for an authorization (e.g., CPT codes, diagnosis codes, UCR, number of days to be authorized complete notes) are available for the coordinators. Ensures services scheduled by outside providers have approved authorization as required and procedure prior to service. Prepares denial letters. Communicates with appropriate parties pertaining to insurance verification and authorization (point of contact for medical coordinators and account managers) Maintain list of admissions and complexes cases. Escalates financial clearance risks (big cases) to supervisors. Provides clear documents (notes)for clearance work according to company protocol Reviews admissions cases (extensions) revising and requesting discharge plans plaining, review medical necessity for level of care (LOC) Provides cross-coverage and training, when needed, for other team members. Maintains productivityand quality performance expectations. Reviews and meets ongoing competency requirements of the role to maintain the skills, REQUIREMENTS
Credentials in a clinical setting (doctor or nurse) from an accredited institution. Minimum 5 years of clinical experience. In-depth knowledge of insurance claims processes and regulations preferred. Ability to analyze and interpret medical data. Excellent analytical and problem-solving skills. Strong written and verbal communication skills. Ability to work independently and as part of a team.
WORKING CONDITIONS
General office working conditions.
BENEFITS
Medical, dental, vision
Retirement
PTO
Hybrid-eligible
WORK ENVIRONMENT
Work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of his job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function.
While performing the duties of this job, the employee will be required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs, balance; stoop, kneel, crouch or crawl; talk or hear. The employee must occasionally lift and or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust to focus. Frequent travel is required, often up to several hours of driving per day. Ability to travel to, attend, and conduct sales presentations. Manual dexterity is required to use desktop computer and peripherals. Exposure to variable weather conditions is likely.
TRAVEL REQUIREMENTS
Minimal to no travel.
NOTE
This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise.
The Company complies with employment regulations as they apply to the location of service.
We are a dynamic enterprise group of managed care and health insurance service companies which have become industry leaders in their diverse specialties. Headquartered in Dallas, Texas, the group has 10 offices around the world, including the United States, Canada, Panama, Ecuador, Colombia, and Dubai, and employs over 700 employees of various nationalities.
DUTIES AND RESPONSIBILITIES
The essential functions include, but are not limited to the following:.
Essential Duties Completes accurate and timely insurance verification, comparing Diagnostic and procedures against policy provision to determined compensability of the service Completes accurate and timely TAT authorization requests (evaluation of emergency or same-day/next-day services, evaluation of non-emergency or scheduled services, evaluation and negotiation of medical fees, evaluation of extensions, extended hospitalizations), including ensuring all necessary data elements needed for an authorization (e.g., CPT codes, diagnosis codes, UCR, number of days to be authorized complete notes) are available for the coordinators. Ensures services scheduled by outside providers have approved authorization as required and procedure prior to service. Prepares denial letters. Communicates with appropriate parties pertaining to insurance verification and authorization (point of contact for medical coordinators and account managers) Maintain list of admissions and complexes cases. Escalates financial clearance risks (big cases) to supervisors. Provides clear documents (notes)for clearance work according to company protocol Reviews admissions cases (extensions) revising and requesting discharge plans plaining, review medical necessity for level of care (LOC) Provides cross-coverage and training, when needed, for other team members. Maintains productivityand quality performance expectations. Reviews and meets ongoing competency requirements of the role to maintain the skills, REQUIREMENTS
Credentials in a clinical setting (doctor or nurse) from an accredited institution. Minimum 5 years of clinical experience. In-depth knowledge of insurance claims processes and regulations preferred. Ability to analyze and interpret medical data. Excellent analytical and problem-solving skills. Strong written and verbal communication skills. Ability to work independently and as part of a team.
WORKING CONDITIONS
General office working conditions.
BENEFITS
Medical, dental, vision
Retirement
PTO
Hybrid-eligible
WORK ENVIRONMENT
Work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of his job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential function.
While performing the duties of this job, the employee will be required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs, balance; stoop, kneel, crouch or crawl; talk or hear. The employee must occasionally lift and or move up to 15 pounds. Specific vision abilities required by the job include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust to focus. Frequent travel is required, often up to several hours of driving per day. Ability to travel to, attend, and conduct sales presentations. Manual dexterity is required to use desktop computer and peripherals. Exposure to variable weather conditions is likely.
TRAVEL REQUIREMENTS
Minimal to no travel.
NOTE
This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise.
The Company complies with employment regulations as they apply to the location of service.