Job Summary:
You will be working for a fast-growing business process outsourcing provider to provide support to one of our largest accounts and leading provider of healthcare services. This provider serves 959 hospitals and 2979 physician practices with over 50 million patient encounters annually.
As an Insurance Plan Clerk, you will be working to ensure that reinstatements, modifications, and cancellations of insurance policies are timely and accurately updated in the necessary databases. You will have an important role in determining the patient's insurance status and extent of insurance benefits, ensuring an efficient billing process for medical providers.
**Responsibilities**:
Duties will be performed by each individual depending on the assignment of responsibilities:
- Perform pre-registration and insurance verification within 3-5 days prior to the date of service for both inpatient and outpatient services. For notification received with less than 3 days advanced notice perform within 24 hours of notification.
- Follow scripted benefits verification and pre-certification format in Meditech custom benefits screen and record benefits and pre-certification information in the approved standard format
- Assign Insurance Plans (IPlan's) accurately
- Perform electronic insurance eligibility confirmation when applicable and document results
- Complete Medicare Secondary Payor Questionnaire as applicable for retention in the managing system (i.e. OnBase)
- Calculate patient cost share and be prepared to collect via phone or make payment arrangement
- Contact the patient via phone (with as much advance notice as possible, preferably 48 hours prior to the date of service)to confirm or obtain missing demographic information, quote/collect patient cost share, and instruct the patient on where to present at the time of appointment
- Receive and record payments from patients for services scheduled.
- Utilize an appropriate communication system to facilitate communication with the hospital gatekeeper
- Ensure appropriate documentation is entered in standard format on the patient record. This should be performed in the applicable Health Information System (i.e. Meditech) and if necessary any other subsidiary systems if they are not automatically updated.
- Contact the physician to resolve issues regarding prior authorization or referral forms
- Research Patient Visit History to ensure compliance with payer-specific payment window rules
- Perform insurance verification and pre-certification follow-up for the prior day's walk-in admissions/registrations and account status changes by an assigned facility as per SSC guidelines.
- Communicates with hospital-based Case Manager as necessary to ensure prompt resolution of pre-existing, non-covered, and re-certification issues
- Meets/exceeds performance expectations and completes work within the required time frames
Skills and Experience:
- English - Spanish Language (Oral and writing 85% or higher), (B2+ or above).
- Must have a high school diploma
- At least 6 months of experience in Data Entry
- Excellent communication skills
- Strong attention to detail
- Comfortable working in a high volume/high demand environment
- Good presentation and a polite, tactful and friendly character.
- This job adjusts to the Eastern Time Zone and follows a US holiday schedule.
About Auxis:
Auxis prioritizes employee growth and development to help you advance your career. Auxis' culture empowers you to be your best in the interest of a common team goal. We are constantly striving to improve our culture and environment and have invested in tools to continue to have better visualization of the pulse of our organization.
- Benefits_
- Health benefits including medical, vision, and dental.
- Transportation subsidy
- Asociacion Solidarista
- Training and development programs
- Employee recognition program
- Paid time off and family paid leave
- Paid day off for your birthday!
