Insurance Verification Representative, Danbury Surgical Center
Company: Surgical Care Affiliates, LLC
Location: Danbury
Posted on: June 23, 2022
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Job Description:
Overview
Join Our Amazing Team! Danbury Surgical Center Affiliates of SCA
has an exciting Insurance Verification Position opportunity we'd
love to hear from you! If you are interested in becoming part of an
organization that is helping to improve healthcare, then this is
the place for you. Your experience in insurance verification is
exactly what we are looking for!
Our team members enjoy the following perks:
* Exceptional benefits (medical, dental, vision, 401K) that begin
the first day of employment
* Positive, friendly environment
Surgical Care Affiliates (SCA) is transforming specialty care in
our communities. We relentlessly create value by aligning
physicians, health plans and health systems around a common goal:
delivering exceptional care and healing to our patients and
communities we serve. We are driven to achieve the quadruple aim in
health care: high quality outcomes and a better experience for
patients and providers, all at a lower total cost of care. As a
national leader in surgical care, SCA's 11,000 teammates operate
more than 260 surgical facilities that serve over 1 million
patients per year. For more information on SCA, visit
www.scasurgery.com.
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Accountabilities / Responsibilities
Responsibilities --
Insurance Verification:
* Verify that sufficient information is available for accurate
verification and eligibility. This step may require direct contact
with the physician office and/or the patient.
* Determine if a secondary insurance should be added to the patient
account ensuring the appropriate payer is selected for Primary
insurance.
* Utilize the centers selected vendor for claims and eligibility
and/or individual payer websites to obtain eligibility, benefits
and/or pre-certs and authorization information.
* Enter the patient insurance information into patient accounting
system ensuring the selection is the appropriate payer and
associated financial class.
* When the patient's insurance is Out of Network notify the manager
immediately. Follow the Policies and Procedures when accepting Out
of Network payers.
* SCA's goal for each patient's insurance verification is complete
and accurate. The insurance verifier will document the findings in
the patient account and will contact the patient with either
estimated co-insurance, co-pay and or deductible amounts due on or
before the date of service as applicable
* The Insurance Verifier will call each patient as part of center
compliance with CMS Conditions for Coverage guidelines in
contacting patient's prior to the date of service to review,
Physician Ownership, Advance Directives and Patient Rights.
Authorization:
* Obtain authorizations from insurance companies/physician offices.
Ensure complete and accurate information is entered into the
patient accounting system and the procedure scheduled, date of
service and facility name are on the authorization. Ensure the
authorization has not expired.
* Enter authorization into patient accounting system. Include the
name/CPT codes effective date of the authorized procedures.
* Ensure high cost implant/supply or equipment rental is included
on authorization.
* Check insurance company approved procedure lists/medical
policies. If procedure is not payable, notify patient. If patient
wants to proceed, obtain signature on Medicare ABN or other
non-covered notification form.
Financial Orientation:
* Calculate co-pay, and estimated co-insurance due from patients
per the individual payer contract per the individual payer contract
and plan as applicable.
* Acceptance of in-network benefits for out-of-network payers must
be pre-approved by SCA Compliance Dept.
* Be familiar with individual payer guidelines and the process of
collecting over the counter
payments/deductibles/copay/co-insurance. Knowledge of payer
contracts including Medicare, Medicaid and other government
contracts and guidelines and workmen's compensation fee
schedule.
* Contact the patient and communicate the center financial
policy
Qualifications
* Bachelor's degree preferred but not required
* Experience checking authorizations
* Must be experienced with cpt codes and medical terminology
* Healthcare experience a must
* Background in healthcare insurance contract, verifying
co-insurance, pre-registration and deductibles preferred
* Detailed and able to work in a high production environment
Keywords: Surgical Care Affiliates, LLC, Danbury , Insurance Verification Representative, Danbury Surgical Center, Healthcare , Danbury, Connecticut
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