Insurance Verification Team Lead, Ambulatory Patient Access

Insurance Verification Team Lead, Ambulatory Patient Access DHR Health - US:TX:Edinburg - Days This position will determine insurance eligibility and financial status by reviewing insurance information via phone or on line verification, calling third party payers to obtain insurance benefits, which include the effective dates of coverage, patient financial responsibility, referral and authorization requirements, in and out of network benefits and maximum coverage. He/She will have the over site for the Insurance Verification Specialists and/or other designees as deemed necessary by the Director, and performs select administrative/clerical duties that assist in the delivery of overall patient care and customer satisfaction.

POSITION EDUCATION/ QUALIFICATIONS:

High School Diploma/ GED is required Good understanding of insurance benefits and medical terminology Previous healthcare experience (2-3 yrs.) is required, physician or hospital experience preferred Previous training and employee supervision (1 yr.) preferred Knowledge of Microsoft Office suite, working knowledge of Excel required Excellent customer service and interpersonal skills Good written and verbal communication skills, with the ability to read, write and speak English are required Ability to communicate clearly and concisely with all levels of management

JOB KNOWLEDGE/EXPERIENCE:

Communicates clearly and concisely and is able to work effectively with other employees, patients and external parties Demonstrates proficiency in Microsoft Office applications, be able to type at least 35 WPM, and good working knowledge of Excel is required. Medical Terminology, ICD Codes, CPT Codes, HCPCS codes, and Modifier knowledge preferred. Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly. Requires reasoning ability, good independent judgment and organizational skills Requires working with frequent interruptions Must project a professional image Responsibilities:

POSITION RESPONSIBILITES:

Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices Ensures timely response to Rejection and Discrepancy Reports Completes assigned reports or tasks as assigned by Director within timeline or by given deadline Monitor IV staff productivity through reports and ensure the team remains at least 3 days ahead in verifying insurance for patients on provider schedules Creates work schedule for team members taking into account times of the month when additional hours are needed to accommodate clinic business and control of overtime. Ex. Beginning of the month, MCD patients Ensures verification of benefits for all accounts on the daily visit schedule and pre-admission roster for the next day's services Becomes the "go to" person for providers and management issues and the trainer for all team members in the Insurance Verification group Confirms billing address, in and out of network benefits and maximum coverage Reviews and confirms patient's financial information by obtaining the insurance carrier information, benefit information, policy number, group name, group number, and the effective date of coverage. Ability to reference ICD-9-CM/ ICD-10-CM, CPT from doctor's order to insurance carrier for eligibility and coverage of procedure Ability to determine timely filing deadline for all insurance carriers Reviews and confirms patient's deductibles, co-pays, and co-insurance with insurance carrier Ability to identify the appropriate coordination of benefits for insurance carrier Utilizes phone or on-line verification systems, i.e. TMHP, Availity, Data Link, internal system, etc., for insurance eligibility and benefits Determines financial status and refers patient for financial screening as appropriate Ensures referral/pre-authorization/pre-certification requirements have been met Obtains pre-certification approval as needed Obtains date of injury, compensable bodily injury, adjuster's name, onset of illness and claim number, for worker's compensation claims, as needed Completes reports as assigned by management within required timeframes Reviews physician order(s) for appropriate patient status (Inpatient/Outpatient) before verifying coverage for procedure Accurately performs basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly Document clearly and concisely all patient benefit information on accounts through the computer system Demonstrates proficiency of personal computers and Microsoft Office applications and other software as required Has appropriate follow up and contact with hospital or patient as necessary When working at the reception desk, checking patients both in and out of the practice properly documenting registration and other notes in the computer, as needed Ensures patient confidentiality requirements are met in accordance with HIPAA/PHI policies and procedures Other duties as assigned

LINES OF RESPONSIBILITES:

(Chain-of-command) Director Ambulatory Patient Access VP of Revenue Cycle Chief Ambulatory Officer

CUSTOMER SERVICE:

Provide excellent customer service to all DHR customers. All employees are required to attend the DHR C.A.R.E.S program which outlines the Customer Service Principals including: Commitment, Accountability, Respect, Excellence and Service.

AGE SPECIFIC :

Employees must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served in his/her assigned unit. The individual must demonstrate knowledge of principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirement relative to his or her age.

AMERICANS WITH DISABILITIES ACT: (ADA) :

A. Essential Duties : Indicated by bold print within performance standards, preceding individual numbered criteria. The following table provides physical requirements that will be associated with, but not limited to, this position: Light/moderate lifting up to 20 lbs, from the floor to shoulder height. Kneeling. Must be able to assist other employees with lifting more than 20 lbs. Walking. Light/moderate carrying up to 20 lbs. Standing/Squatting. Straight pulling. Sitting. Pulling hand over hand. Pushing. Repeated bending. Stooping/Bending. Reaching above shoulder. Climbing Stairs. Simple grasping. Dual simultaneous grasping. Depth Perceptions needed. Ability to see. Identify Colors. Operating office equipment. Twisting. Operating mechanical equipment. Ability to read and write. Ability to hear verbal communication without aid. Ability to comprehend written/verbal communication. Other: Ability to deal with stress. OSHA Category - III B. Working Conditions : The individual spends over 95% of his/her time in an air-conditioned environment with varying exposures to noise. There is protection from weather conditions but not necessarily from temperature changes. The position does have low exposure to malodorous, infectious body fluids from patients and some minimal exposure to noxious smells from cleansing agents. C. Occupational Exposure: This position has minimal to no exposure to blood, body fluids, or tissues and is an OSHA Category III (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Person who performs these duties are not called upon as part of their employment Renaissance Medical Foundation