1 Insurance Verification Specialist FT Remote Job in Arlington, TX
Remoteworker Us is Hiring a Remote Insurance Verification Specialist FT Remote
Job Purpose: Responsibilities include verification of eligibility and benefits for outpatients for all types of insurances as well as ensuring that required authorization or pre-certifications are in place.
Minimum Requirements: High School diploma or equivalent required. Minimum 2 years of experience as a hospital verifier or equivalent. Extensive knowledge of Medicare and other government payer rules and regs, and ability to understand and apply Managed Care contract terms.
Essential Job Responsibilities:
- Verify eligibility and benefits
- Verify effective date.
- Change incorrect insurance products (HMO vs. PPO, etc.) which will cause an account to prorate incorrectly.
- Follow up on incorrect demographic and insurance information which can impede cash flow and collection efforts.
- On WC, verify employer name and address.
- Determine if a plan is self-funded or fully-funded to aid in future collection activity and determine whether or not to pursue prompt pay.
- Determine if authorizations and referrals are needed and follow up with hospital and physicians’ offices until complete.
- Determine if family deductibles apply to patient.
- Determine if there are life-time or annual maximum benefits.
- Determine maximum out of pocket expense.
- Verify coordination of benefits.
- Ask if pre-existing condition clause applies, and if so document the details and forward to the hospital.
- Determine the patient financial responsibility based on the costs, procedures scheduled and specifics of the individual managed care contracts.
- Run reports to determine current average charges for procedures.
- Determine if implants will be involved, and if so, how they are covered by the insurance.
- Check for inpatient only procedures for Medicare patients on Addendum E.
- Check for HASC appropriate procedures on TMHP website for Medicaid.
- Determine Medicare coinsurance based on procedures listed in Addendum B.
- Do medical necessity checks for Medicare O/P and day surgery procedures based on diagnosis and procedures ordered and notify hospital when those checks fail.
- Review physician orders as needed to verify scheduling.
- Communicate status conflicts to hospital case management/CDI specialist.
- Performs other duties as assigned.
Job Summary
Full Time
$43k-52k (estimate)
06/21/2024
07/19/2024
The job skills required for Insurance Verification Specialist FT Remote include Managed Care, etc. Having related job skills and expertise will give you an advantage when applying to be an Insurance Verification Specialist FT Remote. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Insurance Verification Specialist FT Remote. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Insurance Verification Specialist FT Remote positions, which can be used as a reference in future career path planning. As an Insurance Verification Specialist FT Remote, it can be promoted into senior positions as a Claims Clerk III that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Insurance Verification Specialist FT Remote. You can explore the career advancement for an Insurance Verification Specialist FT Remote below and select your interested title to get hiring information.
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