Outpatient Payer Source Specialist, 40hrs/wk, Wellness Club

JOB DESCRIPTION

Job Title:  Outpatient Payer Source Specialist
Job Code: 880354      
Immediate Supervisor: Clinic Manager                                                 
Status: Non-exempt                  

DEPARTMENT FUNCTION/JOB OVERVIEW

Responsible for verifying, recording, and revising financial payer information and reviewing patient demographic information for Outpatient Therapy. Responsible for obtaining and monitoring authorizations as needed for third party payment.  Responsible for providing and when necessary, explaining patientâ??s insurance benefits and securing an acknowledgement of patientâ??s financial responsibility related to services rendered. Other responsibilities include typing, word processing, faxing, and photocopying.  Work will be performed in an ethical and legal manner following organizational policies, processes, protocols and procedures. Responsible for quality service delivery and internal/external customer relations for Madonna as a whole, including upholding the mission and values for the department and facility.

ESSENTIAL FUNCTIONS

1. Responsible for obtaining pre-authorizations, referrals and continual authorizations for patients receiving outpatient rehabilitation when necessary.
2. Works with clinicians to request extensions from insurance companies when necessary.
3. Is accountable for validating new patient insurance information entered by scheduling staff.
4. Responsible for verification of any insurance information that has not been completed upon admission.
5. Responsible for obtaining verification of insurance benefits and completion of insurance benefit forms.
6. Responsible for obtaining detail information to facilitate payment such as third party administrator and case manager requests.
7. Responsible for performing job duties of Outpatient Service Specialist as outlines in that job description when needed.
8. Responsible for communication with insurance workers compensation case managers, employers and third party administrators to ensure the best benefits and coverage possible for patients.
9. Work with outpatient service specialists to ensure that patients have their insurance benefits communicated, explains and secures an acknowledgement of patientâ??s financial responsibility related to services rendered.
10. Responsible for communicating with clinicians about patient benefits:
11. Ensuring that the insurance verifications are documented and put into the patient's chart for the clinicians to read.
12. Follow up to additional authorizations and/or physician referrals.
13. Communicates with Patient Financial Services for understanding insurance company procedures and changes; and loading procedures of Affinity; and for resolution of problems related to collections.
14. Provide training on insurance processes and tasks to those indicated. Communicate with various insurance companies, attorneys, hospitals, other extended care facilities, and governmental agencies to obtain and/or verify necessary demographic, financial and liability information.
15. Follow instruction from supervisor to perform other functions as assigned in order to achieve the goals within the department as well as within the facility.
16. Must be able to operate copier, telephone, fax machine and have proficient computer skills, including e-mail, word processing, spreadsheet functions.
17. Maintain and ensure a safe environment for the department.  Handles and operates all necessary equipment and performs required duties according to established safety standards to maintain compliance with regulations and prevent injury. Adhere to and participate with infection prevention guidelines.
    
    
    PHYSICAL DEMANDS AND ENVIRONMENTAL CONDITIONS
    
    Light work - Walk/stand constantly while stooping, pulling/ pushing cabinets, reaching/climbing to retrieve material, twisting at desk to reach, type, answer phone and occasional lifting of approximately 20 pounds.  Manual dexterity and acuity for computer entry.  Clear speaking voice and average hearing for phone communications.  Requires sufficient sight to see and read reports and computer screen.
    
    QUALIFICATIONS (Education/training and/or Experience)

• High school equivalency with one year post-high school education plus one year work experience in a related area required.
• dditional relevant work experience would be considered in lieu of formal post-high school education.
• Working knowledge of Medicare, Medicaid, Workers Compensation and commercial insurance required.
• Must have working knowledge of personal computers, word processing software, preferably Word and other Microsoft office programs (Access, Outlook, Excel, etc.), and office machines.
• Must have excellent grammar, spelling and organizational skills with the ability to problem solve.
• Must be able to work in demanding situations without adverse reaction and interact in a positive manner with staff and public, either in person or by telephone.
• May be required to obtain/maintain CPR for Health Care Provider/CPR for Professional Rescuer, based off clinical need and delegation.
  
  Background checks are conducted.  When specific authorization forms are requested so that full background and history can be obtained, employees/applicants must sign the form(s) requested.