Insurance Verification Representative (FT) - Trails Edge Surgery Center
Company: Surgical Care Affiliates, LLC
Location: Bonita Springs
Posted on: January 17, 2023
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Job Description:
Overview Today, SCA Health has grown to 11,000 teammates who
care for 1 million patients each year and support physician
specialists holistically in many aspects of patient care. Together,
our teammates create value in specialty care by aligning
physicians, health plans and health systems around a common goal:
delivering on the quadruple aim of high-quality outcomes and a
better experience for patients and providers, all at a lower total
cost of care. As part of Optum, we participate in an integrated
care delivery system that enables us to support our partners as
they navigate a complex healthcare environment, Only SCA Health has
a dynamic group of physician-driven, specialty care businesses that
allows us to customize solutions, no matter the need or challenge:
We connect patients to physicians in new and differentiated ways as
part of Optum and with our new Specialty Management Solutions
business. We have pioneered a physician-led, multi-site model of
practice solutions that restores physician agency by aligning
incentives to support growth and transition to value-based care. We
lead the industry in value-based payment solutions through our
Global 1 bundled payment convener, that provides easy predictable
billing to patients. We help physicians address everything beyond
surgical procedures, including anesthesia and ancillary service
lines. The new SCA Health represents who we are today and where we
are goingand the growing career opportunities for YOU.
Responsibilities Insurance Verification: Verify that sufficient
information is available for accurate verification and eligibility.
This step may require direct contact with the physician office
and/or the patient. Determine if a secondary insurance should be
added to the patient account ensuring the appropriate payer is
selected for Primary insurance. Utilize the centers selected vendor
for claims and eligibility and/or individual payer websites to
obtain eligibility, benefits and/or pre-certs and authorization
information. Enter the patient insurance information into patient
accounting system ensuring the selection is the appropriate payer
and associated financial class. When the patient's insurance is Out
of Network notify the manager immediately. Follow the Policies and
Procedures when accepting Out of Network payers. SCA's goal for
each patient's insurance verification is complete and accurate. The
insurance verifier will document the findings in the patient
account and will contact the patient with either estimated
co-insurance, co-pay and or deductible amounts due on or before the
date of service as applicable The Insurance Verifier will call each
patient as part of center compliance with CMS Conditions for
Coverage guidelines in contacting patient's prior to the date of
service to review, Physician Ownership, Advance Directives and
Patient Rights. Authorization: Obtain authorizations from insurance
companies/physician offices. Ensure complete and accurate
information is entered into the patient accounting system and the
procedure scheduled, date of service and facility name are on the
authorization. Ensure the authorization has not expired. Enter
authorization into patient accounting system. Include the name/CPT
codes effective date of the authorized procedures. Ensure high cost
implant/supply or equipment rental is included on authorization.
Check insurance company approved procedure lists/medical policies.
If procedure is not payable, notify patient. If patient wants to
proceed, obtain signature on Medicare ABN or other non-covered
notification form. Financial Orientation: Calculate co-pay, and
estimated co-insurance due from patients per the individual payer
contract per the individual payer contract and plan as applicable.
Acceptance of in-network benefits for out-of-network payers must be
pre-approved by SCA Compliance Dept. Be familiar with individual
payer guidelines and the process of collecting over the counter
payments/deductibles/copay/co-insurance. Knowledge of payer
contracts including Medicare, Medicaid and other government
contracts and guidelines and workmen's compensation fee schedule.
Contact the patient and communicate the center financial policy
Qualifications Bachelor's degree preferred but not required
Experience checking authorizations Must be experienced with cpt
codes Detailed and able to work in a high production environment
Healthcare experience a must Local or within driving distance
Bachelor's degree preferred but not required Experience checking
authorizations Must be experienced with cpt codes Detailed and able
to work in a high production environment Healthcare experience a
must Local or within driving distance
Insurance Verification: Verify that sufficient information is
available for accurate verification and eligibility. This step may
require direct contact with the physician office and/or the
patient. Determine if a secondary insurance should be added to the
patient account ensuring the appropriate payer is selected for
Primary insurance. Utilize the centers selected vendor for claims
and eligibility and/or individual payer websites to obtain
eligibility, benefits and/or pre-certs and authorization
information. Enter the patient insurance information into patient
accounting system ensuring the selection is the appropriate payer
and associated financial class. When the patient's insurance is Out
of Network notify the manager immediately. Follow the Policies and
Procedures when accepting Out of Network payers. SCA's goal for
each patient's insurance verification is complete and accurate. The
insurance verifier will document the findings in the patient
account and will contact the patient with either estimated
co-insurance, co-pay and or deductible amounts due on or before the
date of service as applicable The Insurance Verifier will call each
patient as part of center compliance with CMS Conditions for
Coverage guidelines in contacting patient's prior to the date of
service to review, Physician Ownership, Advance Directives and
Patient Rights. Authorization: Obtain authorizations from insurance
companies/physician offices. Ensure complete and accurate
information is entered into the patient accounting system and the
procedure scheduled, date of service and facility name are on the
authorization. Ensure the authorization has not expired. Enter
authorization into patient accounting system. Include the name/CPT
codes effective date of the authorized procedures. Ensure high cost
implant/supply or equipment rental is included on authorization.
Check insurance company approved procedure lists/medical policies.
If procedure is not payable, notify patient. If patient wants to
proceed, obtain signature on Medicare ABN or other non-covered
notification form. Financial Orientation: Calculate co-pay, and
estimated co-insurance due from patients per the individual payer
contract per the individual payer contract and plan as applicable.
Acceptance of in-network benefits for out-of-network payers must be
pre-approved by SCA Compliance Dept. Be familiar with individual
payer guidelines and the process of collecting over the counter
payments/deductibles/copay/co-insurance. Knowledge of payer
contracts including Medicare, Medicaid and other government
contracts and guidelines and workmen's compensation fee schedule.
Contact the patient and communicate the center financial policy
Keywords: Surgical Care Affiliates, LLC, Bonita Springs , Insurance Verification Representative (FT) - Trails Edge Surgery Center, Other , Bonita Springs, Florida
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