Remote Medical Benefit Verification Specialist – Tucson

Job Description

As a Remote Benefit Verification Specialist at Community Health Systems – Shared Services Center, you’ll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, and building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including health insurance, flexible scheduling, 401k and student loan repayment programs. The Remote Benefit Verification Specialist position is remote and full time, which is 40 hours per week. Orientation is Monday-Friday, 8:00am – 4:30pm CST for approximately one week. After orientation, the training and normal working hours are Monday-Friday, 8:00am – 4:30pm AZ MST (AZ MST time zone).

Required Experience:

• One (1) year Hospital/Physician Business office experience to include knowledge of collections, EOB processing, and billing. Minimum one (1) year experience in a medical facility, ambulatory surgery facility, or acute-care hospital working with insurance verification

Preferred Experience:

• Two (2) years Hospital/Physician Business office experience to include knowledge of collections, EOB processing, and billing. Two (2) years experience in a medical facility, ambulatory surgery facility, or acute-care hospital working with insurance verification

Essential Duties and Responsibilities:

• Provide professional, accurate, timely insurance verification and notification for outpatient diagnostic services, observation and inpatient services.
• Responsible for the timely verification of medical insurance benefits for the service scheduled or service being provided via website and/or calling the payor (Managed Care payors, Governmental payors and Commercial payors)
• Verifies insurance eligibility, benefits and preauthorization/precertification/referral guidelines following the 16 components of verification
• Meets all required standards for assuring thorough documentation of the 16 components of insurance verification where applicable based on payor
• Ensure all account activity is documented in the computer system timely and thoroughly
• Using payor websites and documentation provided by the physician’s office determine if the scheduled service is medically necessary based on payor guidelines by CMS and commercial payors
• Working knowledge of Medical Necessity protocols for scheduled tests and procedures and notifies physician office 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
• Notify Benefit Verification Manager immediately when uninsured or underinsured patients are identified
• Responsible for maintaining performance standards that ensure the department is operating at peak proficiency and that established goals are consistently being met.
• Work is performed under tight deadlines.
• Maintain effective communication with patients, physicians, medical office staff and the Health Management facilities and departments.
• Maintaining current knowledge and understanding of government rules, regulations.
• Ability to work with technology necessary to complete job effectively. This includes, but is not limited to, SCI, phone technology, PULSE/DAR products, insurance verification / eligibility tools, patient liability estimation tools, and scanning technology.
• Ability to perform all other duties as assigned or requested.
• This is a fully remote opportunity.

We know it’s not just about finding a job. It’s about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible.

Community Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.

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