What are the responsibilities and job description for the Lead Insurance Verifier position at WMC Health?
Job Details : Job Summary :
The Lead Insurance Verifier is responsible for leading the payment resolution analysts that process all out of network insurance claims to ensure appropriate payments are received. This individual assists staff in payment negotiations with payers, provides good faith estimates to potential patients and processes and follows up on independent dispute resolution appeals
Responsibilities :
- Reconciles billing and payment data on an automated system to maintain and update receivable status on out of network payments posted on the patients' account.
- This position ensures coordination and communication between departments becoming a resource for the patient, physician, and facility. Communicates with Doctor's office staff any issues with patients such as difficulty reaching the patient or inability to make an acceptable Financial Arrangement
- Maintain current knowledge of and competency with numerous Federal, State and other regulatory body compliance regulations and third-party insurance plans
- Must be able to follow directions and to perform work according to department standards when no directions are given
- Communicates with third party payers by means of correspondence or by telephone to start payment negotiation on accounts that are deemed "underpaid" per set guidelines.
- Reviews payments to assess if account will be sent for independent dispute resolution.
- Prepares and submits appeals for independent dispute resolution.
- Negotiates with third party payors on underpayments.
- Tracks outcomes.
- Communicates with all customers (patients, families, staff, physicians, vendors, etc) in a helpful and courteous manner while extending exemplary customer service
- Works collaboratively with other departments to ensure accuracy of patient billing.
- Responsible for maintaining and implementing new process / procedures based on regulatory updates.
- Any other responsibility as directed.
Qualifications / Requirements : Experience : Must have at least 1 year billing and follow up experience in a hospital environment or 3 years billing and follow up experience in a physician's office.
Education :
High school or equivalency diploma and combination of years of experience, college education or healthcare certification equivalent.
Licenses / Certifications :
N / A
Other :
Special Requirements : N / A
About Us :
NorthEast Provider Solutions Inc.
Benefits :
We offer a comprehensive compensation and benefits package that includes :
