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Insurance Verification Rep

Baylor St Luke's Medical Group The Woodlands, Texas
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The posted compensation range of $13.22 - $18.17 /hour is a reasonable estimate that extends from the lowest to the highest pay CommonSpirit in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.

Requisition ID 2023-294060 Employment Type Full Time Department Cardiology Clinic Hours/Pay Period 80 Shift Day Weekly Schedule Monday - Friday (8:00 AM - 5:00 PM) Remote No Category Administrative and Clerical
Overview

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. & from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.


Responsibilities

Under general supervision, Insurance Verification Representative is responsible for verifying patient’s insurance information and obtains authorization prior to scheduled visits in accordance with HIPAA guidelines, internal standards and procedures, and other regulatory requirements. Responsible for interpreting coverage limitations, patient versus insurance coverage, follows up with payors/patients to secure account and responds to insurance verification questions. Work closely with physicians, patients, and other healthcare staffs to ensure authorizations cover the services needed and that correct information is obtained.

1. Ensure insurance coverage by telephone.
 2. Resolve any issues with coverage and escalates complicated issues to manager.
 3. Interview patients and completes all paperwork necessary to ensure the admitting process is efficient and all clinic and regulatory policies are in compliance.
 4. Coordinate with clinical staff to obtain charge information for all patients.
 5. Code procedures performed and diagnosis on charge.
 6. Assign appropriate ICD-9, CPT and HCPCS code(s) to accurately support the need and documentation for each service.
 7. Coordinate copies of medical documentation with physician charges to support billing to third-party payers.
 8. Identify physician services provided, but not accurately documented in the medical record.
 9. Resolve routine patient billing inquiries and problems.
 10. Perform other duties as assigned.


Qualifications

Education

* Bachelor degree in related field preferred.

Experience

* 2 – 4 years healthcare experience preferred.  

Skills

* Thorough understanding of insurance payor reimbursement, collection practices, and accounts receivable follow-up required.
 * Broad knowledge of the content, intent and application of HIPAA, federal and state regulations.
 * Understanding of insurance payor reimbursement and collection practices.
 * Knowledge of insurance industry and basic medical terminology/abbreviations preferred.
 * Understands health insurance and medical costs, including coding.
 * Requires good customer skills.
 * Good communication skills.
 * Proficient computer skills.
 * Possess a strong work ethic and a high level of professionalism.

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While you’re busy impacting the healthcare industry, we’ll take care of you with benefits that may include health/dental/vision, FSA, matching retirement plans, paid time off, tuition assistance, adoption assistance, and more!

Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified.

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Equal Opportunity

CommonSpirit Health™ is an Equal Opportunity/Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law. For more information about your EEO rights as an applicant, please click here.

CommonSpirit Health™ will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c). External hires must pass a post-offer, pre-employment background check/drug screen. Qualified applicants with an arrest and/or conviction will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, ban the box laws, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances. If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA). CommonSpirit Health™ participates in E-Verify.