19 days old

Outpatient Payer Source Specialist - Full-time, 36hrs/wk, day shift, Mon - Fri

Madonna Rehabilitation Hospital
Lincoln, NE 68508
  • Job Code
    05139030183
Job Title: Outpatient Payer Source Specialist
Job Code:
880064

Status: Non-exempt

JOB OVERVIEW

Responsible for verifying, recording, and revising financial payer information and reviewing patient demographic information for TherapyPlus Main Campus. Responsible for obtaining and monitoring authorizations as needed for third party payment. Responsible for providing and when necessary, explaining patients insurance benefits and securing an acknowledgement of patients financial responsibility related to services rendered. Other responsibilities include typing, word processing, faxing, and photocopying. Responsible for quality service delivery and internal/external customer relations for the department and Madonna as a whole, including upholding the mission and values for the department and facility.

ESSENTIAL FUNCTIONS

  1. Responsible for obtaining preauthorizations, 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 periodically performing job duties of OP Service Specialist as outlines in that job description.

(PEOPLE)
  1. Responsible for communication with insurance workers compensation case managers, employers and third party administrators to ensure the best benefits and coverage possible for patients.
  2. Works with outpatient service specialists to ensure that insurance benefits are communicated to pateitns and families and, an acknowledgement of patients financial responsibility related to services rendered is received.
  3. Responsible for communicating with clinicians about patient benefits:
  4. Ensuring that the insurance verifications are documented and put into the patient's chart for the clinicians to read.
  5. Follow up to additional authorizations and/or physician referrals.
  6. 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.
  7. Provides training on insurance processes and tasks to those indicated.
  8. Communicates with various insurance companies, attorneys, hospitals, other extended care facilities, and governmental agencies to obtain and/or verify necessary demographic, financial and liability information.
  9. 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.

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 and two years work experience required. Additional 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 on 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.

EQUAL OPPORTUNITY: It is the policy of Madonna not to discriminate on the basis of race, creed, color, religion, sex, age, disability, national origin, pregnancy, receipt of public assistance, marital status, Vietnam era veteran status, genetic information, or any protected class specified by law, statute, or ordinance to any applicants, employees, volunteers, and Board members. Madonna is an Equal Opportunity Employer.





Posted: 2020-11-08 Expires: 2020-12-07
Sponsored by:
ADP Logo
Sponsored by:
Bank of America Logo

Featured Jobs[ View All ]

Featured Employers

Before you go...

Our free job seeker tools include alerts for new jobs, saving your favorites, optimized job matching, and more! Just enter your email below.

Share this job:

Outpatient Payer Source Specialist - Full-time, 36hrs/wk, day shift, Mon - Fri

Madonna Rehabilitation Hospital
Lincoln, NE 68508

Join us to start saving your Favorite Jobs!

Sign In Create Account
Powered ByCareerCast