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    Eligibility Representative Insurance Verification Specialist - Enterprise, United States - Medical Center Enterprise

    Medical Center Enterprise
    Medical Center Enterprise Enterprise, United States

    1 week ago

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    Description
    Job duties include:

    1. Verifies detailed insurance benefits, medical necessity, and authorization/referral guidelines, consistently prioritizing and following the established verification processes.
    2. Communicates outstanding documentation requests, required account follow-up, and payor issues to the appropriate facility contacts.
    3. Responsible for maintaining performance standards that ensure the department is operating at peak proficiency and that established goals are consistently being met while maintaining effective communication with patients, physicians, medical office staff, and both internal and external co-workers.
    4. Calculates the estimated patient financial responsibility via the estimation tool.
    5. Notates all actions performed in the applicable host system(s) immediately.
    6. Performs all other duties, as assigned or requested, while adhering to strict deadlines
    -screening referred self-pay patients for programs such as Medicare, Medicaid, Medicaid for nursing home placement, Crime Victims, vocational rehabilitation, QMB, SSI, and any/all other third party coverage including other available local, state, and federal programs in addition to the hospital's financial assistance program

    -providing point of service collections for self-pay patients, patients who have balances after insurance or Medicare payments, and patients that do not qualify for any programs/coverage.

    Minimum qualifications:

    -at least 1 year of healthcare experience

    -proficiency in Microsoft Word and Excel

    -meet productivity standards ( there is a potential quarterly bonus structure in place for high performers )

    -comply with hospital policies

    - Bilingual in Spanish is preferred and additional compensation added

    Prior experience in collections and knowledge of HIPAA,EMTALA, and PHI are a plus.
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