Insurance Verification Representative

Requisition ID
2020-139203
Employment Type
Full Time
Department
Revenue Cycle Management
Hours Per Pay Period
80
Facility
CHI Health
Shift
Day
Standard Hours
Days
Work Schedule
8 Hour
Location
NE-OMAHA

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

Opportunity to work from home after 6 months of employment!

Job Summary / Purpose

This job is responsible for corresponding with both commercial and government health insurance payers to address and resolve outstanding insurance balances and non-coding denials in accordance with established standards, guidelines and requirements.  An incumbent conducts follow-up process activities through phone calls, online processing, fax and written correspondence, leveraging work queues to organize work efficiently.  Work also includes reviewing insurance remittance advices, researching denial reasons and resolving issues through well-written appeals.

Essential Key Job Responsibilities

  1. Follows-up with insurance payers to research and resolve unpaid insurance accounts receivable; makes necessary corrections in the practice management system to ensure appropriate reimbursement is receive.
  2. Applies a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received.
  3. Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements.
  4. Resubmits claims with necessary information when requested through paper or electronic methods.
  5. Anticipates potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify.
  6. Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.
  7. Resolves work queues according to the prescribed priority and/or per the direction of management and in accordance with policies, procedures and other job aides.
  8. Assists with unusual, complex or escalated issues as necessary.
  9. Organizes open accounts by denial type or payer to quickly address in bulk with representatives over the phone, via spreadsheet, utilizing an on-line payer portal, etc.
  10. Accurately documents patient accounts of all actions taken in billing system.

 

 

 

Qualifications

  • Knowledge of medical insurance and payer contracts
  • CPT and ICD code knowledge required
  • Experience with denials and insurance follow-up
  • Two years revenue cycle experience

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