About this role
Role Overview
- Verify the prescriber is currently credentialed with the facility or through Select Health, or verifies the prescriber has an active license in good standing.
- Ensure clinically appropriate documentation is received timely from medical providers/facilities, and ensures medical necessity is appropriate for type of services being provided.
- Evaluate the need for, and if appropriate, confirms Letter of Medical Necessity has been received to ensure third party payment.
- Ensure orders include an appropriate ICD-10 code.
- Collaborate with clinicians and intake managers to minimize risk associated with medical necessity or financial sponsorship changes that affect the reimbursement.
- Make appropriate corrections in the patient's record to ensure accuracy in order to prevent denials and/or problems with billing and reimbursement.
- Obtain insurance eligibility and benefit information, ensures authorization requirements are completed within the required timeframe, and maintains appropriate authorizations throughout patient treatment at the specified clinic.
- Ensure ongoing eligibility based on clinical documentation for medical necessity and ensure reauthorization functions are completed in a timely manner, based on individual payer requirements.
- Estimate cost of service using ICD-10 or CPT codes.
- Performs calculations using insurance benefit information to accurately estimate patient responsibility.
- Analyzes patient/guarantor's previous account history to guide financial conversation.
- Educate patient regarding Medicare ABN and potential costs associated with non-coverage, as well as ramifications of not signing the form.
- Sends the Medicare ABN to the patient if necessary.
- Communicates the ABN status to the specific Infusion Clinic.
Requirements
- Experience as a Financial/Eligibility Counselor, Health insurance related experience (billing, authorizations, etc.), or Certificate in healthcare coding.
- Demonstrated customer service experience in a healthcare, insurance, or financial field.
- Demonstrated outstanding public relations and interpersonal skills.
- Demonstrated organizational skills.
- Multi-tasker with demonstrated ability to complete work timely and accurately.
- Demonstrated self-starter and team oriented, flexibility to adapt to change, ability to work with minimal supervision.
Benefits
- We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.