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Benefits Verification in Wickenburg at SUNSPIRE HEALTH

Date Posted: 4/11/2018

Job Snapshot

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Job Description

General Purpose of The Benefits Verification Position:

The Benefits Verification position will be responsible for contacting insurance companies, on behalf of Sunspire treatment facilities, to verify patient benefits. The benefits verification specialist will ask appropriate questions regarding patient’s benefits and complete data entry and/or appropriate forms to document patient’s benefit coverage.

Primary Responsibilities of the Benefits Verification position (include but are not limited to):

  • Collects and reviews all patient insurance benefit information.

  • Maintains effective communication with patients, physicians, medical office staff and the Health Management facilities and departments regarding insurance status.

  • Working knowledge of Medical Necessity protocols for scheduled tests and procedures and notifies facility of any tests that do not meet necessity guidelines.

  • Communicates and educates patients and physician practices to ensure compliance with identified payor requirements as needed.

  • Validates that all necessary referrals, pre-certification and/or authorizations for scheduled service are on file and that they are valid for the scheduled test being performed.

  • Reviews and resolves preauthorization/precertification/referral issues that are not valid and contacts insurance carriers to verify/validate requirements to ensure accuracy and avoid potential denial and contact ordering physician office if necessary to have authorization submitted.

  • Calculates patient estimated portions via estimation tool and contacts patient prior to the scheduled appointment to notify patient of their patient responsibility.

  • Notifies Benefit Verification Manager immediately when uninsured or underinsured patients are identified

  • Maintains current knowledge and understanding of government rules, regulations.

  • Submits claims timely and accurately.

Job Requirements

Education, Skills and Experience Requirements:

  • High School graduate or equivalent.

  • At least one (1) year of experience in a medical facility, inpatient treatment facility, or acute-care hospital working in insurance verification.

  • Knowledge of CPT, HCPCS, ICD-9 and medical terminology.

  • Excellent interpersonal skills required to communicate with direct staff and internal/external customers.

  • Must be detail oriented.

  • Able to work under pressure and meet deadlines as well as be flexible and dependable.

  • Strong interpersonal, organizational and analytical skills.

  • Structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.