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Patient benefits Specialist (per Diem)

Company: Cape Cod Healthcare Inc.
Location: Plymouth
Posted on: June 4, 2019

Job Description:

* Prior to a patient's first visit, verify insurance coverage and benefits including co-payments and deductibles. * Verify insurance coverage and benefits on a daily basis through Recipient Eligibility Verifications Systems and various payor websites and/or via telephone. * Communicate with patients regarding charges that may be in question including copayments and deductibles or refer them to Patient Financial Services for further questions. * Assist in Prior Authorizations, verify the accuracy of demographic and payor information. Notify admissions, scheduling and other related departments regarding concerns and corrections. * Obtain initial and ongoing authorizations for outpatient visits, maintain tracking system, notify providers when continued authorizations are due and reapply as required. Follow up with insurance carriers to make sure that authorizations have been completed. * Work closely with support staff to complete daily charge/capture reconciliation. * Receive Explanation of Benefits and Authorizations and enter into the system as required. * Use CPT, DSM-V, HCPC, and ICD 10 codes to enter daily charges into the system and post payments as needed. * Work closely with Psychiatric Financial Manager to develop systems to improve revenue cycle management. * Audit daily reports that track daily billing rejections and discharge accounts in order to reconcile deficiencies. * Keep current on new policies and procedures of third party payors, hospital procedures and any insurance updates in order to educate providers and staff. * Resolve billing edit errors generated via in-house scrubber reports and claim checks as well as through individual payor editing programs. Resubmit claims where appropriate. * Comply with departmental and organizational policies/procedures including but not limited to, dress code, telephones, cell phones, and computers. * Perform other work related duties as requested/directed by management. Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers in a manner that reflects Cape Cod Hospital's commitment to CARES: compassion, accountability, respect, excellence and service. * Ability to read, write and communicate in English. * High School Diploma or GED. * Ability to add, subtract, multiply and divide accurately, manually and by using a calculator. * Working knowledge and proficiency with Microsoft Office Suite (Word, Excel, Outlook), use of Internet. * Soarian Clinicals and Financials or similar program experience preferred. * One year (within the past 5 years) experience in insurance verification/authorization Payor processes hospital and physician billing requirements; or one year recent (within the past 3 years) comprehensive work with 3rd party billing to include DSM-V diagnosis and CPT procedures. * Mental Health Carve-Out Insurance experience preferred. * ZRSDL2017

Keywords: Cape Cod Healthcare Inc., Plymouth , Patient benefits Specialist (per Diem), Other , Plymouth, Massachusetts

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