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Insurance Verification Lead (CVC)


Mesa, Arizona | Arizona | Denver, Colorado | Tampa, Florida | Charlotte, North Carolina | Nashville, Tennessee | Atlanta, Georgia | Phoenix, Arizona | Austin, Texas

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Job ID 21000FWI

Available Openings 1

PURPOSE AND SCOPE:

Ensures efficient and effective verification of insurance benefits and eligibility for patients scheduled to receive services using insurance websites and telephone. Creates patient accounts and adds demographic and insurance information for patients who receive services.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

  • Under general supervision and utilizing functional knowledge and expertise, verifies and documents patients’ insurance information and eligibility per company requirements and department standard operating procedures ensuring completeness and accuracy to facilitate timely and accurate billing and collections activities.

  • Provides support, guidance, and subject matter expertise to junior staff, intervening as needed to address challenging and complex situations. Assists with coordinating and assigning daily tasks and workload to team prioritizing as needed to ensure established timelines are met.

  • Verifies patient insurance information the day prior to the scheduled date of service.

    • Obtains and uses a schedule or list of patients scheduled for service the next day to verify patient insurance eligibility and benefits with the listed insurance.

    • Verifies if an authorization by the patient’s insurance carrier is required for the scheduled procedures.

    • Verifies state Medical Assistance coverage, in addition to listed coverage.

    • Verifies Medicare coverage for all patients over the age of 65, in addition to listed coverage.

    • Searches appropriate database for the scheduled patients to determine if there are outstanding balances or information needed from the patient(s).

    • Communicates any questions/concerns with regard to unclear or discrepant insurance information to the appropriate staff.

    • Receives final list of patients who received service the day after the service for inputting into the appropriate database. Reviews information entered to ensure accuracy and completeness.

    • Updates the internal daily status log with information for patients receiving service according to dept policy such as at the point of final schedule, insurance verification, and registration to track the pertinent dates for each of the patients. Ensures that all documents are received and processed within the established timelines. Documents each date of service and records month-to-date patient detail for each location.

    • Updates the dashboard report/file for each location. Enters the most recent date of service for which insurance was verified and patient accounts were registered in Medical Manager for each location. Dashboard file frequently monitored by management to ensure established timelines are met.

    • Conducts quality audits to ensure consistent and superior execution of functions by junior staff. Documents audit findings, reviews with junior staff and reports to supervisor. Provides training as needed.

    • Presents all payer and team issues and updates in the weekly leadership meeting.

    • Regularly informs team members regarding payer updates and team policy and procedural changes.

    • Other duties as assigned.


PHYSICAL DEMANDS AND WORKING CONDITIONS:

  • The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Prolonged sitting at a computer work station. Extensive use of telephone and ability to maintain a focused train of thought while multitasking in the process of investigating billing issues. Able to concentrate on detail oriented data for prolonged period of time. Able to adjust routine to accommodate departmental needs and goals; must be able to lift light objects; retrieve files from cabinets which may involve upward or downward physical mobility; can focus on computer monitor for prolonged periods and clearly see data in paper form with small font printing; can effectively communicate via telephone.

EDUCATION:

High School Diploma required; Associate’s Degree desirable; and Bachelor’s Degree strongly preferred


EXPERIENCE AND REQUIRED SKILLS:

  • 4 or more years’ experience in medical billing, with an emphasis on payment posting/reconciliation with a HS Diploma, 2 or more years’ experience with a bachelor’s degree.

  • Basic understanding medical terminology,

  • Proficient with PCs, Microsoft Office applications and able to navigate and understand computerized patient accounting applications.

  • Strong mathematical aptitude.

  • Excellent written and verbal communication skills.

  • Strong organizational and time-management skills with attention to detail.

  • Positive attitude and team-oriented approach

  • Excellent knowledge of commonly used concepts, practices and procedures related to medical billing and follow-up.

  • Good understanding of payer contracts and reimbursement.

EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity

 

Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.